Ondansetron plus dexamethasone is superior to ondansetron alone in the prevention of emesis in chemotherapy-naive and previously treated patients

Joss, R; Bacchi, M.; Buser, K.; Kirchner, V.; Neuenschwander, H.; Orth, B.; Aapro, Matti; Thürlimann, Beat

doi:10.1093/oxfordjournals.annonc.a058803

Cited by 40 publications

(11 citation statements)

References 12 publications

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“…The wellbeing of patients is further enhanced by the excellent tolerability of the 5HT 3 antagonists, which does not change appreciably when they are combined with dexamethasone, except that in our study constipation occurred more frequently with the dexamethasone combination. Joss et al made a similar observation with an ondansetron-dexamethasone combination [12]. Dexamethasone is not known to cause obstinate constipation; hence, a further confirmation of this observation in other trials is needed to exclude a random finding.…”

Section: Discussionmentioning

confidence: 79%

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

Drechsler

Bruntsch

Eggert

et al. 1997

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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.

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Section: Discussionmentioning

confidence: 79%

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

Drechsler

Bruntsch

Eggert

et al. 1997

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“…Joss et al [13] recently reported data on nausea and vomiting during a period of 5 days after chemotherapy including cisplatin above 50 mg/m 2. As antiemetics, single doses of dexamethasone (20 rag) or placebo were given i.v.…”

Section: Discussionmentioning

confidence: 99%

“…Corticosteroids exert antiemetic effects as single drugs and enhance the antiemetic effects of 5-HT3 receptor antagonists on acute nausea and vomiting [1,12,13,15,17]. With the improved possibilities of controlling acute symptoms, delayed nausea and vomiting appear as a separate entity [14].…”

Section: Introductionmentioning

confidence: 99%

Single high-dose dexamethasone improves the effect of ondansetron on acute chemotherapy-induced nausea and vomiting but impairs the control of delayed symptoms

Peterson

Hursti

Börjeson

et al. 1996

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The introduction of serotonin receptor (5-HT3) antagonists has improved the control of acute nausea and vomiting induced by cancer chemotherapy, but they seem to have little or no effect on delayed symptoms. Corticosteroids are known to reduce both acute and delayed nausea and vomiting. The aim of the present study was to test the hypothesis that a single high dose of dexamethasone (20 mg), a long-acting corticosteroid, given after cisplatin and in addition to ondansetron (8 mg three times a day), would enhance the control of both acute and delayed nausea and vomiting. A group of 104 chemotherapy-naive ovarian cancer patients, scheduled for at least three cycles of combination chemotherapy including cisplatin (50 mg/m2), were randomly allocated to receive either dexamethasone or placebo in addition to ondansetron. Two-thirds of the patients received doxorubin and melphalan on the day before cisplatin and 1/3 received doxorubicin immediately before cisplatin. Unexpectedly we found, in all three chemotherapy cycles, that patients receiving dexamethasone suffered from more delayed nausea and vomiting than patients receiving placebo. In patients with no acute nausea or vomiting, the boomerang effect of dexamethasone could be seen on the first day after chemotherapy. In a follow-up study on 5 patients not included in the randomized trial, dexamethasone induced a pronounced reduction in urinary cortisol excretion on the day after chemotherapy with a return to normal excretion on day 2. It is concluded that a single high dose of dexamethasone does not seem appropriate for controlling delayed nausea and vomiting.

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“…Loannidis JP and colleagues reported the benefit of addition of dexamethasone to prevent both acute and delayed emesis in a meta-analysis of 32 randomized controlled trials for patients receiving moderate or highly emetic chemotherapy. The addition of dexamethasone increased the chance of acute vomiting prevention by 25% and the risk ratio for emesis protection was 1.25 [21][22][23][24][25] (Table 4). …”

Section: Nausea and Vomiting Induced By Intravenous Chemotherapymentioning

confidence: 99%

Nausea and Vomiting in Cancer Patients: Topic Review

Ibrahim¹

2014

J Palliat Care Med

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Nausea and vomiting are known side effects for cancer therapy. The prevalence is around 40-80%. The level of emetoginicity varies based on different factors. The potential receptors involved in emesis pathway are dopamine receptors, 5-hydroxytryptamine type 3 receptors and neurokinin receptors. The main guidelines for prevention of nausea and vomiting are ASCO, NCCN, MASCC/ESMO. These guidelines recommend three antiemetic drugs for highly emetic chemotherapy and two antiemetic drugs for moderately emetic chemotherapy. While for low risk regimens single antiemetic might be used and for minimal risk regimens antiemetic is not routinely recommended. Non pharmacological therapy might be considered as well. There are different tools for assessment of nausea and vomiting such as EORTC-QLQ-C30 and FACT-G. The Multinational Association of Supportive Care in Cancer (MASCC) tool individually address both acute and delayed nausea and vomiting, available in different languages and has iPhone/iPad application. Proper prevention of this side effect is highly recommended to improve patient quality of life, to avoid further complications as dehydration, electrolyte imbalance and to ensure continuation of treatment plan.

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Ondansetron plus dexamethasone is superior to ondansetron alone in the prevention of emesis in chemotherapy-naive and previously treated patients

Cited by 40 publications

References 12 publications

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

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

Single high-dose dexamethasone improves the effect of ondansetron on acute chemotherapy-induced nausea and vomiting but impairs the control of delayed symptoms

Nausea and Vomiting in Cancer Patients: Topic Review

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