Systematic review of antiemetic therapy for low emetogenic chemotherapy: comparing 5-HT₃ receptor antagonists and...

Chemotherapy-induced nausea and vomiting (CINV) significantly impact quality of life of patients with cancer. Although antiemetic guidelines exist for low-emetic chemotherapy (LEC), recommendations vary across international guidelines and direct evidence comparing 5-HT3 receptor antagonists (5-HT3 RAs) with dexamethasone monotherapy is lacking.

We conducted a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for randomized controlled trials, nonrandomized comparative studies, and observational studies directly comparing 5-HT₃ RA with dexamethasone monotherapy in adult patients with LE, using PubMed, the Cochrane Library, CINAHL, and Ichushi-Web from January 1990 to December 2020.

A systematic search identified 427 articles (87 from PubMed, 337 from the Cochrane Library, and three from Ichushi-Web), with three additional records identified through other sources. After the first screening of 430 articles, 425 records were excluded, and five records were used for full-text assessment. Following the second screening, five full-text articles were excluded for not meeting the inclusion criteria.

This systematic review identified no direct comparative evidence. Future efforts to strengthen the evidence base should include not only prospective comparative trials where feasible but also observational studies, real-world data analyses, and other complementary approaches that better reflect routine clinical practice.