Effectiveness of Anti-emetics for the Prophylaxis of Cisplatin-Induced Delayed Emesis : A Systematic Review

Abstract

We performed a systematic review of the eŠectiveness of anti-emetics for prophylaxis of cisplatin-induced delayed emesis using meta-analysis. We selected 12 reports of randomized controlled trials from MEDLINE (1966 2003 and The Cochrane Library Issue 1, 2003. Nine of these reports were evaluated as high quality and the others as low quality according to the evaluation criteria of Jadad et al., and only the high-quality reports were subjected to meta-analysis. The statistical results obtained from all 12 reports were also compared with those obtained from the 9 reports of high quality. Corticosteroids signiˆcantly reduced the occurrence of delayed emesis. Metoclopramide tended to reduce the occurrence of delayed emesis, although not to a signiˆcant extent. In contrast, 5-HT 3 receptor antagonists did not show a signiˆcant prophylactic eŠect on delayed emesis. Combination treatments using corticosteroids with metoclopramide or 5-HT 3 receptor antagonists did not show signiˆcant additional beneˆts over corticosteroids alone. In conclusion, treatment with corticosteroids without additional metoclopramide or 5-HT 3 receptor antagonists appears to be preferable for the prevention of delayed emesis induced by cisplatin.

Cisplatin-induced emesis: systematic review and meta-analysis of the ferret model and the effects of 5-HT3 receptor antagonists

“…Overall, 5-HT 3 receptor antagonists reduced the emetic response to the same extent during the acute and delayed phases, which contrasts with findings reported in the majority of clinical studies, describing limited or non-significant effect of 5-HT 3 receptor antagonists during the delayed phase [57, 73]. This discrepancy may be explained by a difference in outcome usually measured in humans (daily incidence, percentage of patients developing emesis) and ferrets (severity, number of R+V).…”

Comparison of Dexamethasone 8 mg and 16 mg for the Prevention of Acute and Delayed Cisplatin-induced Emesis in Patients with Lung Cancer

“…The DEX 8 mg group and the DEX 16 mg group received DEX intravenous injection 30 min prior to CDDP. All patients then received a 5 HT 3 antagonist intravenous injection 30 min before CDDP. Protection from acute nausea (day 1) was signiˆcantly superior in the DEX 16 mg group compared with the DEX 8 mg group (DEX 8 mg, 76.5％; DEX 16 mg, 100％).…”