Metoclopramide, Dexamethasone, or Palonosetron for Prevention of Delayed Chemotherapy-Induced Nausea and Vomiting After Moderately Emetogenic Chemotherapy (MEDEA): A Randomized, Phase III, Noninferiority Trial

Abstract

Disclosures of potential conflicts of interest may be found at the end of this article.

Does a single dose of palonosetron have any role in preventing acute chemotherapy-induced nausea and vomiting in pediatric osteosarcoma patients without dexamethasone? A randomized clinical trial

“…Due to the multiple adverse effects of chemotherapeutic agents, a combination of antiemetic agents must be tested, such as preventing the stimulation of dopamine D2 receptor in the chemoreceptor trigger zone (CTZ) and binding neurokinin-1 (NK-1) receptor with substance P in the area postrema. 19,20 Although the addition of a corticosteroid improves the potency of 5-HT3 receptor antagonists against CINV in different clinical trials, the best standard single-dose treatment with 5-HT3 receptor antagonists for pediatric emesis has not yet been demonstrated, particularly in the acute chemotherapy phase, i.e., the first 24 h. Few studies have reported the potency of a dopamine D2 receptor antagonist in the prevention of acute emesis 9 ; however, the guidelines for the prevention of CINV do not consider those regimens due to faults in the study design.…”

“…9 Palonosetron at fixed doses has been found to be safe and potent enough to prevent CINV, whether acute or delayed, in adults. 20 However, there is no consensus on using palonosetron at fixed doses in pediatric patients receiving chemotherapy for various malignancies. Recently, the POGO and Multinational Association of Supportive Care in Cancer/European Society for Medical Oncology (MASCC/ESMO) guidelines have been released on the inclusion of palonosetron for pediatric patients receiving MEC and HEC.…”

“…In certain studies, gender, age, the type of tumor, the emetogenicity of the regimen, and the choice of prophylactic agents have been shown to influence the rate of CR. 15,[19][20][21][22][23] In the present study, factors like gender, age, the treatment regimen, and the number of rescue medications (dexamethasone) were evaluated as potential risk factors that might affect the response during the overall treatment. It was found that the use of dexamethasone was the only statistically significant predisposing risk factor.…”

Effect of Acupuncture on Delayed Emesis for the Patients Who Received High-Emetogenic Chemotherapy with Standard Antiemetic Prophylaxis (KHMC-HO-01): An Open-Label, Randomized Study

“…Furthermore, all patients were administered metoclopramide for 5 days, which is approved as prophylaxis for delayed emesis in Korea. Although metoclopramide is not recommended as prophylaxis in the recent guidelines, it aids with managing delayed or breakthrough emesis [ 4 , 25 , 26 ]. Since our study focused on the delayed phase, we decided to use a combination of all available drugs that can prevent and/or relieve possible symptoms.…”

Strategies to Mitigate Chemotherapy and Radiation Toxicities That Affect Eating

“…In the past 25 years, major advances in nausea and vomiting reduction from chemotherapy and/or radiation therapy have improved this situation. These include the following: common use of selective serotonin receptor (5-HT3 also known as 5HT) antagonists for immediate N/V, neurokinin receptor antagonists (aprepitant and fosaprepitant) for delayed nausea, and the recognition of corticosteroids and olanzapine in front-line anti-emetic regimens for chemotherapy and radiation [19,21,[84][85][86][87][88]. Although N/V from chemotherapy and/or radiation remains common, there are many effective strategies to ameliorate N/V and improve eating behaviors during chemotherapy and radiation as detailed in Table 3.…”