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Delayed emesis: a dilemma in antiemetic control
1Ochsner Cancer Institute, New Orleans, LA 70121.
Summary
Delayed emesis, a significant challenge in antiemetic therapy, affects many patients post-chemotherapy. While combination therapies show promise, further research is needed to effectively manage this persistent side effect.
Area of Science:
- Oncology
- Pharmacology
- Clinical Medicine
Background:
- Delayed emesis is a primary limitation in antiemetic treatment efficacy.
- High-dose cisplatin (≥100 mg/m2) is associated with nearly 90% incidence of delayed emesis.
- The incidence and severity of delayed emesis in other settings are less understood.
Purpose of the Study:
- To review the current understanding of delayed emesis in chemotherapy patients.
- To evaluate the efficacy of existing antiemetic strategies.
- To highlight implications for future clinical study designs.
Main Methods:
- Review of existing clinical studies on delayed emesis.
- Analysis of antiemetic treatment efficacy, including combination therapies and single-agent serotonin antagonists.
- Discussion of the temporal onset of delayed emesis.
Main Results:
- Combination oral metoclopramide and dexamethasone can halve the incidence of delayed emesis.
- Single-agent serotonin antagonists have shown limited efficacy.
- Delayed emesis can commence as early as 16 hours post-chemotherapy.
Conclusions:
- Despite some treatment advances, delayed emesis remains a significant problem for many patients.
- Current antiemetic strategies require further optimization.
- Future research should incorporate findings on the early onset of delayed emesis and employ robust methodologies.