Comparison of three tropisetron-containing antiemetic regimens in the prophylaxis of acute and delayed chemotherapy-induced emesis and nausea

Abstract

There is still controversy as to what constitutes the optimal therapy for acute and delayed chemotherapy-induced emesis and nausea. We conducted a threearmed randomized multi-centre study in 193 chemotherapy-naive patients receiving highly emetogenic chemotherapy inducing both acute and delayed symptoms (cisplatin 650 mg/m 2 , carboplatin 6300 mg/m 2 , cyclophosphamide 6750 mg/m 2 , ifosfamide 61.5 g/m 2 on day 1). Group A: 1!5 mg tropisetron i.v. on day 1c2, then 10 mg p.o. (oral dose now recommended: 5 mg); group B: tropisetron as for Acdexamethasone, 20 mg i.v., on days 1c2, then 4 mg i.v./p.o.; group C: tropisetron as for Acmetoclopramide, 20 mg i.v.c2!10 mg p.o. on day 1, then 3!10 mg p.o. Treatment was continued for at least 2 days after the end of chemotherapy. Tropisetroncdexamethasone was significantly superior to tropisetron alone both for acute (Pp0.0064) and delayed (Pp0.0053) emesis. Complete control of acute and delayed emesis (nausea) was achieved in 80% (75%) and 53% (46%) in group A, 97% (90%) and 80% (58%) in group B, and 86% (80%) and 49% (45%) in group C. Patients completely asymptomatic during the whole cycle accounted for 26% of those in group A, 49% in group B and 28% in group C. The most frequent adverse events were constipation (16.6%), headache (7.3%) and tiredness (7.3%). Once-daily tropisetroncdexamethasone over several days is well tolerated and is a simple means of achieving further significant improvement in the efficacy of tropisetron against acute and delayed symptoms.

Olanzapine Combined With Standard Antiemetic Regimens for Prevention of Chemotherapy Therapy-Induced Nausea and Vomiting: A Single-Center Experience From South India

“…A number of antiemetic regimens exist but are not fully effective. The most commonly used antiemetics such as 5-hydroxytryptamine-3 (5HT 3 ) antagonists, dexamethasone, or neurokinin-1 receptor antagonists prevent emesis only in 60-70% of cancer patients receiving highly emetogenic chemotherapy (HEC) [8,9]. Hence, new drugs and regimens are being explored for more effective control of nausea and vomiting.…”

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“…Finally two open, randomized, multicenter studies have been published [28,29]. The first compared tropisetron (5 mg i.v.…”

“…plus 10 mg orally b.i.d on day 1 followed by 10 mg t.i.d. orally until two days after the end of chemotherapy) in patients submitted to highly and moderately emetogenic chemotherapy [29]. Quality of life in this study was documented using a newly developed, validated but not yet published, colour scale.…”

The antiemetic interaction of Δ9-tetrahydrocannabinol when combined with tropisetron or dexamethasone in the least shrew

“…One possible cause of this anomaly is the species differences between humans and shrews. Clinically, DEX and a 5-HT 3 antagonist together have demonstrated the ability to block the vast majority of acute vomiting due to CIS (Drechsler et al, 1997; Sorbe et al, 1994), but were ineffective even in combination when administered to the house musk shrew ( Suncus murinus ; Sam et al, 2003). In contrast to Suncus , however, to date the data related to emesis in the least shrew have been very similar to those collected for people (Darmani, 1998; Darmani et al, 2008; Darmani et al, 1999; Ray et al, 2008; and unpublished observations), and our previously published single-dose data regarding DEX administered alone have indeed shown reduced emetic activity (Darmani et al, 2005).…”