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Reducing chemotherapy-induced nausea and vomiting. Current perspectives and future possibilities
A Del Favero1, F Roila, M Tonato
1Institute of Internal Medicine I, University of Perugia, Italy.
Drug Safety
|December 1, 1993
Summary
Effective antiemetic guidelines for chemotherapy involve combining ondansetron and dexamethasone for high-dose cisplatin, while dexamethasone plus metoclopramide helps prevent delayed nausea and vomiting. Corticosteroids are recommended for moderately emetogenic drugs.
Area of Science:
- Oncology
- Pharmacology
- Clinical Therapeutics
Background:
- Chemotherapy-induced nausea and vomiting (CINV) are significant adverse effects impacting patient quality of life.
- Recent advancements have improved CINV prevention strategies over the past decade.
Purpose of the Study:
- To provide evidence-based guidelines for selecting optimal antiemetic treatments for patients undergoing chemotherapy.
- To analyze the efficacy and toxicity of various antiemetic regimens for different chemotherapy types.
Main Methods:
- Analysis of clinical trial data for patients receiving moderately to severely emetogenic chemotherapy.
- Evaluation of antiemetic combinations including ondansetron, dexamethasone, metoclopramide, and corticosteroids.
- Assessment of treatment outcomes for acute and delayed emesis.
Main Results:
- For high-dose cisplatin, ondansetron plus dexamethasone is highly effective for acute emesis.
- Dexamethasone plus metoclopramide shows promise for delayed emesis, though breakthrough symptoms occur.
- Corticosteroids are effective and safe for moderately emetogenic chemotherapy; serotonin (5-HT)3 antagonists are reserved for refractory cases due to cost.
Conclusions:
- Established guidelines exist for managing CINV with specific drug combinations based on emetogenic potential.
- Further research is needed for high-dose regimens (e.g., bone marrow transplantation), optimizing common regimens, and rescue therapies.
- Newer serotonin (5-HT)3 antagonists may offer only marginal improvements in efficacy and tolerability.