Nausea and emesis remain significant problems of chemotherapy despite prophylaxis with 5‐hydroxytryptamine‐3 antiemetics

Abstract

BACKGROUNDClinical reports suggest that nausea remains a side effect of chemotherapy despite widespread use of serotonin receptor antagonists. This study summarized the frequency, timing, and intensity of postchemotherapy nausea for patients receiving doxorubicin, cisplatin, or carboplatin.METHODSThree hundred sixty chemotherapy‐naïve patients (73% female) were enrolled in a study testing the ability of an information intervention to reduce nausea. Of these, 322 subjects completed the Morrow Assessment of Nausea and Emesis (MANE), as well as a 5‐day self‐report diary, at Cycle 1 (300 subjects completed the MANE and self‐report diary at Cycle 2). All patients received a 5‐hydroxytryptamine‐3 receptor antagonist (ondansetron) with dexamethasone on the day of treatment.RESULTSSeventy‐six percent of the patients developed nausea during the 5‐day period, beginning with the Cycle 1 infusion, and 73% of patients reported delayed nausea (DN) during Days 2–5. The proportions were similar during Cycle 2. Fifty‐five percent of patients described their DN as being of moderate or greater intensity compared with 28% of patients who described acute nausea. Carboplatin was less likely to cause DN than either of the other agents (56% of 106 patients compared with 75% of 47 receiving cisplatin and 83% of 169 taking doxorubicin). The mean peak DN severity was 4.34 (range, 1–7) for doxorubicin, which was significantly higher than the mean peak value for carboplatin (3.66) but was not significantly different from the mean peak value for cisplatin (4.26). Eighteen percent of patients did not experience nausea until Day 3 or later.CONCLUSIONSDespite prophylaxis with ondansetron, the majority of patients receiving one of these common chemotherapy agents experienced nausea. The frequency of DN was nearly twice that of acute nausea. Results show the need for continued development of antiemetics that are effective against DN. Cancer 2003;97:2880–6. © 2003 American Cancer Society.DOI 10.1002/cncr.11408

Incidence of chemotherapy‐induced nausea and emesis after modern antiemetics

“…In various surveys in the U.S. 9 and Europe, 5,10 an incidence rate of 25-38% for delayed emesis and 55-60% for delayed nausea has been observed. Of greater note is the observation of an incidence rate of 18 -30% for delayed emesis and 23-36% for delayed nausea, even in the absence of acute nausea and emesis.…”

Acute and delayed nausea and emesis control in pediatric oncology patients

“…chemotherapy that contained either carboplatin, cisplatin, or doxorubicin and showed that 76% of patients developed some nausea during the first 5 days of receiving their chemotherapy. 16 No details were provided in that report regarding the antiemetic regimen(s) employed after Day 1 of chemotherapy. A second study focused primarily on moderately emetogenic chemotherapy and documented acute nausea in Ͼ 30% of patients and acute emesis in Ն 12% of patients.…”

“…Studies of antiemetic control rates that combine dissimilar emetogenic regimens together to report overall success rates may not be a valid means of describing actual rates of nausea and emesis control in clinical practice. 10,16,17 This heterogeneity in antiemetic response among different chemotherapy regimens indicates the need for quality improvements and may guide clinicians to focus research on chemotherapy regimens for which antiemetic therapy is inadequate. Potential future studies that can be derived from this research include targeting certain chemotherapy regimens to test newer antiemetic agents (e.g., aprepitant) in children, redefining and/or combining the acute and delayed phases for antiemetic studies in children who receive chemotherapy, and conducting studies to examine markers of chemotherapy-induced nausea and emesis that may predict the heterogeneity in response for children of different ages.…”

“…Two large evaluations were performed recently in the adult population. 16,17 One of those studies examined the first 2 courses of i.v. chemotherapy that contained either carboplatin, cisplatin, or doxorubicin and showed that 76% of patients developed some nausea during the first 5 days of receiving their chemotherapy.…”

Preventive Effects of Low-dose Dexamethasone for Delayed Adverse Events Induced by Carboplatin-based Combination Chemotherapy

“…1,2) In the late 1990s, several professional organizations such as the Multinational Association of Supportive Care in Cancer, the National Comprehensive Cancer Network, and the American Society of Clinical Oncology, convened antiemetic guideline groups and published theˆndings of these expert panels. 3 7) Each of these documents was based on analyses of the available published trials and provided nearly identical recommendations.…”