Nausea and vomiting induced by arterial chemo-embolization in patients with hepatocellular carcinoma and the antiemetic effect of ondansetron hydrochloride

Abstract

To determine the incidence of nausea and vomiting and the antiemetic effect of ondansetron hydrochloride (OND) in patients with hepatocellular carcinoma treated with arterial chemo-embolization, we studied 59 patients with hepatocellular carcinoma who were treated with transcatheter arterial embolization (TAE) or lipiodolized transcatheter arterial infusion (L-TAI). We investigated the incidence of nausea and vomiting and the amount of food intake when TAE or L-TAI was performed. All patients who experienced nausea and vomiting received OND administered prophylactically at the time of the next TAE or L-TAI to evaluate the antiemetic effect of the drug. Cumulative rates of nausea and vomiting during the week following arterial chemo-embolization were 44.8% and 27.6%, respectively. There was a tendency for the incidence to be higher in patients treated with the anticancer agent zinostatin stimalamer (SMANCS) than in those treated with epirubicin hydrochloride (EPI). Regarding food intake, 53.1% of the patients stated that they ate "half or more than half" of the food provided on the day of arterial chemo-embolization. The rate improved as time went on. In 5 patients who experienced nausea and vomiting at the time of arterial chemo-embolization, nausea and vomiting were inhibited satisfactorily by OND. When arterial chemo-embolization was performed, antiemetic treatment for approximately 3 days was necessary to improve patients' quality of life (QOL) to an acceptable level, and OND was found to be effective for the purpose in our 5 patients who had experienced nausea and/or vomiting at the previous treatment.

Management of Postembolization Syndrome Following Hepatic Transarterial Chemoembolization for Primary or Metastatic Liver Cancer

“…Levels of nausea were determined in 2 studies 8,18 by using grading criteria such as the toxicity assessment tool, and the third study 25 used patient diaries and a 5-point food intake scale. All studies reported a positive association between the use of ondansetron and post-TACE nausea and vomiting.…”

Dexamethasone prevents TACE-induced adverse events

“…The application of a 5-HT3 receptor antagonist was proven to treat TACE-induced nausea and vomiting efficiently, and postoperative pain could be controlled by analgesic agents, such as oxycodone. [ 28 , 29 ] Considering the metabolic load on the liver caused by multiple medications, dexamethasone, which has promising anti-inflammatory effects and inhibits immunoreactions, was expected to prevent PES. Several retrospective and prospective clinical trials have confirmed the function of dexamethasone in reducing TACE-induced adverse events.…”

Effect of palonosetron and dexamethasone administration on the prevention of gastrointestinal symptoms in hepatic arterial chemoembolization with epirubicin

“…Since TACE is repeatedly performed, management of postembolization syndromes is also important to maintain the patient's quality of life and advance to smooth treatment of HCC. There are several studies on premedication to prevent postembolization syndromes [7,9,[11][12], but the medication to be used and the best dosage are still not established. In this study, we have examined the effect of palonosetron and dexamethasone on the prevention of gastrointestinal symptoms in TACE.…”

“…Nausea is the most common and one of the most painful adverse events in systemic chemotherapy. The incidence of nausea in TACE with EPI is approximately 30-50% [9][10]. In systemic chemotherapy, guidelines for the administration of antiemetic drugs are instituted, and prophylactic administration of antiemetic drugs, such as NK 1 receptor antagonists, 5-HT3 receptor antagonists, and dexamethasone, are necessary according to the risk classification of nausea for each anticancer drug.…”