Antiemetic efficacy of combination therapy with granisetron plus prednisolone plus the dopamine D 2 antagonist metopimazine during multiple cycles of moderately emetogenic chemotherapy in patients refractory to previous antiemetic therapy

Abstract

Effective antiemetic treatment of patients who have previously experienced chemotherapy-induced nausea and vomiting is difficult. The aim of this study was to evaluate the antiemetic efficacy of a single intravenous dose of granisetron plus a 3-day oral treatment with prednisolone 25 mg once a day plus metopimazine 30 mg four times a day in patients refractory to previous antiemetic treatment with granisetron or with prednisolone plus metopimazine. The study population was made up of 25 consecutive women with stage I or II breast cancer, who were treated with multiple cycles of adjuvant cyclophosphamide, fluorouracil plus methotrexate or cyclophosphamide, epirubicin plus fluorouracil given i.v. every 3 weeks. Patients received the three-drug combination of antiemetics during a total of 113 cycles of chemotherapy. No emetic episodes were reported in 88.9% cycles on day 1, in 94.7% cycles on days 2 through 5 and in 85.8% cycles on days 1 through 5 after chemotherapy. No nausea was reported in 43.4% cycles on day 1, in 49.6% cycles on days 2 through 5 and in 34.5% cycles on days 1 through 5. Nineteen patients (76.0%) completed the scheduled nine cycles of chemotherapy, 1 being withdrawn because of > or =5 emetic episodes and 5, because they were not satisfied with the antiemetic treatment. The treatment was well tolerated. In conclusion, granisetron plus prednisolone plus metopimazine is a highly effective antiemetic treatment in patients receiving moderately emetogenic chemotherapy refractory to antiemetic therapy with granisetron or prednisolone plus metopimazine.

Role of Corticosteroids in Palliative Care

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Role of Corticosteroids in Palliative Care

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Applicability of the National Comprehensive Cancer Network/Multinational Association of Supportive Care in Cancer Guidelines for Prevention and Management of Chemotherapy-Induced Nausea and Vomiting in Southeast Asia: A Consensus Statement

“…If a switch is not effective or feasible, the addition of an agent from a different class, such as a dopamine antagonist, 50 olanzapine, 51 benzodiazepine, 6 or phenothiazine, is recommended. 6 Olanzapine has been shown to be more effective than metoclopramide in this setting.…”

How do we manage patients with refractory or breakthrough emesis?

“…As metopimazine is not widely available, a study with low-dose metoclopramide, also a D2 receptor antagonist, should be performed to confirm these observations [19].…”

Role of Corticosteroids in Palliative Care

“……”

Applicability of the National Comprehensive Cancer Network/Multinational Association of Supportive Care in Cancer Guidelines for Prevention and Management of Chemotherapy-Induced Nausea and Vomiting in Southeast Asia: A Consensus Statement

“…If a switch is not effective or feasible, the addition of an agent from a different class, such as a dopamine antagonist, 50 olanzapine, 51 benzodiazepine, 6 or phenothiazine, is recommended. 6 Olanzapine has been shown to be more effective than metoclopramide in this setting.…”

How do we manage patients with refractory or breakthrough emesis?

“…As metopimazine is not widely available, a study with low-dose metoclopramide, also a D2 receptor antagonist, should be performed to confirm these observations [19].…”

Role of Corticosteroids in Palliative Care

“……”

Applicability of the National Comprehensive Cancer Network/Multinational Association of Supportive Care in Cancer Guidelines for Prevention and Management of Chemotherapy-Induced Nausea and Vomiting in Southeast Asia: A Consensus Statement

“…If a switch is not effective or feasible, the addition of an agent from a different class, such as a dopamine antagonist, 50 olanzapine, 51 benzodiazepine, 6 or phenothiazine, is recommended. 6 Olanzapine has been shown to be more effective than metoclopramide in this setting.…”

How do we manage patients with refractory or breakthrough emesis?

“…As metopimazine is not widely available, a study with low-dose metoclopramide, also a D2 receptor antagonist, should be performed to confirm these observations [19].…”