The three-drug combination of a 5-hydroxytryptamine-3 (5-HT(3)) serotonin receptor antagonist, dexamethasone, and aprepitant is recommended before chemotherapy of high emetic risk. For persons receiving chemotherapy of high emetic risk, there is no group of patients for whom agents of lower therapeutic index are appropriate first-choice antiemetics. These agents should be reserved for patients intolerant of or refractory to 5-HT3 serotonin receptor antagonists, neurokinin-1 receptor antagonists, and dexamethasone. The three-drug combination of a 5-HT3 receptor serotonin antagonist, dexamethasone, and aprepitant is recommended for patients receiving an anthracycline and cyclophosphamide. For patients receiving other chemotherapy of moderate emetic risk, the Update Committee continues to recommend the two-drug combination of a 5-HT3 receptor serotonin antagonist and dexamethasone. In all patients receiving cisplatin and all other agents of high emetic risk, the two-drug combination of dexamethasone and aprepitant is recommended for the prevention of delayed emesis. The Update Committee no longer recommends the combination of a 5-HT3 serotonin receptor antagonist and dexamethasone for the prevention of delayed emesis after chemotherapeutic agents of high emetic risk. CONCLUSION The Update Committee recommends that clinicians administer antiemetics while considering patients' emetic risk categories and other characteristics.

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Palonosetron (Aloxi) is a 5-HT(3)-receptor antagonist antiemetic indicated for the prevention of acute and delayed nausea and vomiting following moderately emetogenic chemotherapy and for acute nausea and vomiting following highly emetogenic chemotherapy. Although it is the fourth member of this class to enter the US market, palonosetron is distinguished by distinct pharmacological characteristics. It has a higher binding affinity for the 5-HT(3 )receptor and a terminal serum half-life at least four times greater than any other available agent of this class (approximately 40 h). The high affinity and long half-life may explain the persistence of antiemetic effect throughout the delayed emesis risk period. The indications for palonosetron are supported by one dose-ranging study and three large, randomised, Phase III studies that all demonstrated at least equivalent activity (and in some cases, superior activity) compared to other 5-HT(3)-receptor antagonists. In spite of the pharmacological differences, the side effect profile of palonosetron is comparable to that of other 5-HT(3)-receptor antagonists. Palonosetron may prove valuable in combination therapy for delayed emesis and may be an appropriate agent for clinical settings, such as multiple-day chemotherapy, where acute emesis is repeatedly induced. Palonosetron provides a convenience advantage if multiple-day 5-HT(3)-receptor antagonist therapy is anticipated and is a unique addition to the antiemetic armamentarium.

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OBJECTIVES:To examine the factors associated with total health care expenditures in newly diagnosed subjects with colorectal cancer (CRC) receiving systemic therapy. METHODS: Patients ages 18-63 years when newly diagnosed with CRC between January 1, 2005 and June 31, 2009 receiving systemic therapy were identified using a large, US-based administrative medical claims (MarketScan) database. At least 6 months of patient history prior to CRC diagnosis and at least 1-year post-index continuous enrollment was required. Patients were followed from initial CRC diagnosis (index date) to disenrollment or June 31, 2010. Chemotherapy and biologic treatments over time were analyzed to identify lines of therapy. Generalized linear regression models were used to estimate total medical expenditures (outcome variable) as a function of number of lines of therapy (key independent variable) and demographic/clinical covariates. The excess expenditures associated with additional lines of therapy were estimated as the difference between predicted medical expenditures for those with 1 st line of therapy versus 2 nd and 3 rd ϩ lines of therapy. RESULTS: A total of 5160 subjects were included with the majority being male (55%) and between ages 51-60 years (52%). After adjusting for demographic, and clinical covariates (comorbidities, metastasis development, and postindex CRC surgery and radiation) and follow-up days, the mean annualized total health care costs (Nϭ5,160) were predicted to be $67,902. Use of 2 nd line and 3 rd line ϩ therapies was associated with an annualized