Antiemetics in children receiving chemotherapy

Area of Science:

• Pediatric Oncology
• Pharmacology

Background:

• Limited research exists on preventing chemotherapy-induced acute emesis in children.
• 5-HT3 antagonists demonstrate superior efficacy and safety compared to older antiemetics like metoclopramide, phenothiazines, and cannabinoids.

Purpose of the Study:

• To review the current evidence on antiemetic drug efficacy in pediatric patients undergoing chemotherapy.
• To establish optimal dosing and scheduling for 5-HT3 antagonists in children.
• To evaluate combination therapies for preventing chemotherapy-induced nausea and vomiting.

Main Methods:

• Review of existing pediatric studies on antiemetic drug prevention of acute emesis.
• Comparison of 5-HT3 antagonists with metoclopramide, phenothiazines, and cannabinoids.
• Analysis of combination therapy efficacy, specifically 5-HT3 antagonists with dexamethasone.

Main Results:

• 5-HT3 antagonists are more effective and safer than older antiemetic agents for pediatric acute emesis.
• Combination therapy with a 5-HT3 antagonist and dexamethasone enhances antiemetic efficacy compared to 5-HT3 antagonists alone.
• Optimal dose and scheduling of 5-HT3 antagonists in children remain undetermined.

Conclusions:

• A combination of a 5-HT3 antagonist and dexamethasone is recommended for all pediatric patients receiving chemotherapy with high or moderate emetogenic potential to prevent acute emesis.
• Further research is needed to determine optimal dosing and scheduling of 5-HT3 antagonists in pediatric populations.
• Current evidence does not address the prevention of chemotherapy-induced delayed and anticipatory emesis in children.