An audit of antiemetic use with CMF chemotherapy

A two-stage retrospective audit of the efficacy of antiemetics used with intravenous cyclophosphamide 600 mg/m2, methotrexate 40 mg/m2 and 5-fluorouracil 600 mg/m2 (CMF) chemotherapy for breast cancer has been performed in a single centre. The first audit stage examined emesis rates for 21 patients using a policy of metoclopramide and dexamethasone initially and reserving 5-HT3 antagonists for failure of this combination. Because of high failure rates, the policy was changed so that granisetron and dexamethasone were used in all patients. The second audit stage examined the effectiveness of this new policy in 28 patients. Nine of 21 patients (43%) in the first audit group changed from metoclopramide and dexamethasone because of nausea or vomiting. Emesis occurred in 15 out of 66 (23%) cycles of CMF when metoclopramide and dexmethasone were used. Only eight of 43 patients had emesis episodes with granisetron and dexamethasone (19%). Emesis occurred with only 16 of 206 CMF cycles with granisetron and dexamethasone (8%). The granisetron and dexamethasone combination is superior to metoclopramide and dexamethasone in the prophylaxis of CMF-induced nausea and vomiting, although it is more expensive. A reduced dose of granisetron, 1 mg rather than 3 mg, may allow similar control of emesis at reduced cost.