Future trends in cancer treatment and emesis control

The treatment of cancer patients has improved over the last few years for a variety of reasons. These include improvements in diagnosis, more potent chemotherapeutic drugs and the introduction of new ways of containing or eliminating cancers by the use of multi-modality treatment regimens often facilitated by the use of chemoprotective agents. Cancer patients have also benefited from an increased awareness of their needs, with health care professionals paying attention to toxicities of treatment and optimising treatment schedules to combine the best possible medical outcome with patient comfort and acceptability of treatment. Thus not all the advances seen in the management of cancer patients have relied upon the introduction of novel anti-tumour agents; important advances have been made by the optimal use of existing drugs, the revision of treatment schedules and better control of the side effects of treatment. One of the more distressing side effects of cancer chemotherapy, having a profound effect on its acceptability to patients, is nausea and vomiting. The introduction over the last 3 years, of ondansetron, the first generally available 5-HT3 receptor antagonist, has had beneficial effects on the management of patients. Through improvements in anti-emetic control ondansetron has provided a better quality of life and is now beginning to impact on the design and administration of conventional chemotherapy treatment schedules. This paper reviews the changes that have been seen with the use of ondansetron and makes several suggestions about areas where clinicians might find a beneficial role for 5-HT3 receptor antagonists.