Prevention of emesis from multiple-day and high-dose chemotherapy regimens

J Natl Compr Canc Netw. 2007 Jan;5(1):51-9. doi: 10.6004/jnccn.2007.0007.

Abstract

The prevention of chemotherapy-induced nausea and vomiting (CINV) has improved significantly with the introduction of the 5-hydroxytryptamine type 3 (5-HT3) receptor antagonists combined with dexamethasone. Most studies have reported on patients undergoing single-day highly or moderately emetogenic chemotherapy. There have been fewer studies and much less success in preventing CINV in patients undergoing multiple-day chemotherapy or high-dose chemotherapy with stem cell transplant. Current practice guidelines suggest the use of a first-generation 5-HT3 receptor antagonist and dexamethasone daily for each day of the multiple-day chemotherapy regimens. This practice seems to control acute CINV, but delayed CINV remains poorly controlled with a complete response (e.g., no emesis, no rescue) of less than 50% in most studies. Three new agents-palonosetron, aprepitant, and olanzapine-have shown high efficacy in preventing acute and delayed CINV in patients undergoing single-day chemotherapy. These agents have high potential for preventing CINV in patients undergoing multiple-day chemotherapy. This article proposes recommendations for their use in clinical trials and in practice.

Publication types

  • Review

MeSH terms

  • Antiemetics / therapeutic use*
  • Antineoplastic Agents / administration & dosage*
  • Antineoplastic Agents / adverse effects
  • Benzodiazepines / therapeutic use
  • Drug Therapy, Combination
  • Humans
  • Isoquinolines / therapeutic use
  • Metoclopramide / therapeutic use
  • Neurokinin-1 Receptor Antagonists
  • Olanzapine
  • Palonosetron
  • Quinuclidines / therapeutic use
  • Serotonin 5-HT3 Receptor Antagonists*
  • Serotonin Antagonists / therapeutic use*
  • Vomiting / chemically induced
  • Vomiting / prevention & control*

Substances

  • Antiemetics
  • Antineoplastic Agents
  • Isoquinolines
  • Neurokinin-1 Receptor Antagonists
  • Quinuclidines
  • Serotonin 5-HT3 Receptor Antagonists
  • Serotonin Antagonists
  • Benzodiazepines
  • Palonosetron
  • Metoclopramide
  • Olanzapine