Cisplatin and Emesis: Aspects of Treatment and a New Trial for Delayed Emesis Using Oral Dexamethasone plus Ondansetron Beginning at 16 Hours after Cisplatin

Abstract

The marked progress in controlling emesis caused by cisplatin characterizes the current status of antiemetic treatment for all chemotherapy. Cisplatin has provided a model for antiemetic studies. Strategies for controlling cisplatin-induced emesis are at least as successful when applied to other chemotherapy, and persistent problems such as delayed emesis and the emesis associated with consecutive-day chemotherapy are also similar to or less severe than those observed with cisplatin. The purpose of this report is twofold: first to outline briefly therapy for cisplatin-induced emesis as illustrated by several new studies, and, second, to report on a new trial that incorporates some different strategies in the control of delayed emesis after cisplatin.

Gender discrepancy observed between chemotherapy-induced emesis and hiccups

“…Hiccups are experienced by cancer patients receiving dexamethasone-based anti-emetic therapy for the prevention of cisplatin-induced nausea and vomiting [10,11,12,13,14,15,16,17,18]. The reported incidence of this complication varies between 3% and 61% [10,11,12,13,14,15,16,17,18].…”

“…The reported incidence of this complication varies between 3% and 61% [10,11,12,13,14,15,16,17,18]. Gralla [17] mentions that hiccups are probably due to corticosteroid medication, but hiccups are an uncommon adverse effect of high-dose corticosteroid administration and only a few cases of dexamethasone-induced hiccups have been reported in the literature [19,20,21,22,23,24,25,26]. The mechanism of corticosteroid-associated hiccups is not known.…”

Mechanisms and Management of Nausea and Emesis

“…This review together with the studies with ondanse tron in the control of delayed emesis show that the combi nation of metoclopramide or ondansetron and dexameth asone are effective [8], However, the efficacy of these combinations is moderate and further studies should be conducted to optimize anticmetic therapy. This may include starting delayed emesis therapy at 16 h rather than at the traditional 24 h as an interesting noncompara tive study indicates that the efficacy of ondansetron plus dexamethasone for delayed emesis may be enhanced by Oncology 1996;53(suppl 1): [1][2][3] Dicato starting the regimen at this time [16]. Information from animal models of delayed emesis may provide further insight into the emetic mechanisms and consequently the most effective treatment [ 1 ].…”

Chemotherapy-Induced Nausea and Vomiting in the Treatment of Gastrointestinal Tumors and Secondary Prophylaxis with Aprepitant

“…Also in patients who failed to respond to one or two previous antiemetic treatments, the combination of palonosetron and dexamethasone seems to be safe and highly effective in controlling acute and particularly delayed CINV [5]. A few years ago, the most effective available prophylaxis for delayed emesis was the combination of a 5HT 3 antagonist or metoclopramide with corticosteroids [6,7]. But even with this combination, approximately 50% of patients receiving highly or moderately emetogenic chemotherapy continued to suffer from delayed vomiting and/or nausea [8][9][10][11][12].…”