Reducing Chemotherapy-Induced Nausea and Vomiting Current Perspectives and Future Possibilities

Favero, A. Del; Roila, Fausto; Tonato, Maurizio

doi:10.2165/00002018-199309060-00004

Cited by 51 publications

(20 citation statements)

References 87 publications

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“…As in previous dolasetron studies [14,15,23,30,31] and other 5-HT 3 antagonists trials [32,33], tiredness and headache were the most commonly reported adverse events. As in previous studies with 5-HT 3 receptor antagonists [3,13,15,22,23,31,32,34], we also noted asymptomatic changes in ECG intervals. None was of clinical consequence or required medical treatment.…”

Section: Discussionsupporting

confidence: 90%

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Open-label comparison of the antiemetic efficacy of single intravenous doses of dolasetron mesylate in pediatric cancer patients receiving moderately to highly emetogenic chemotherapy

Coppes

Lau

Ingram

et al. 1999

Med. Pediatr. Oncol.

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Background Nausea and vomiting are among the most unpleasant adverse side effects of cancer therapy. Procedure An open‐label dose‐escalation study was conducted to assess the appropriate intravenous dose of dolasetron for pediatric patients undergoing chemotherapy. Patients received dolasetron in single intravenous doses of 0.6 (n = 10), 1.2 (n = 12), 1.8 (n = 12), or 2.4 (n = 12) mg/kg 30 min before receiving emetogenic chemotherapy. Pharmacokinetic parameters were evaluated at each dose level and efficacy was evaluated over the first 24 hr following the administration of dolasetron. Results A complete response was achieved in 10% of patients given 0.6 mg/kg, 25% of patients given 1.2 mg/kg, 67% of patients given 1.8 mg/kg, and 33% of patients given 2.4 mg/kg. Peak plasma concentrations (Cmax) were observed between 0.33 and 0.75 hr following dolasetron infusion. Cmax and area under plasma concentration‐time (AUC) increased with larger doses of dolasetron, while terminal disposition half‐life (t1/2) and apparent clearance (Clapp) were not significantly changed with respect to dose. For 1.8‐mg/kg dolasetron, the t1/2 was 4.98 hr and the maximum plasma concentration (tmax) 0.47 hr. Adverse events were mild to moderate. No serious events occurred. Conclusions. This study suggests that a single intravenous dose of 1.8 mg/kg is the optimum single intravenous dose for controlling chemotherapy‐induced emesis in pediatric patients. Med. Pediatr. Oncol. 33:99–105, 1999. © 1999 Wiley‐Liss, Inc.

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Section: Discussionsupporting

confidence: 90%

“…Until recently, the dopamine receptor antagonist metoclopramide was considered the cornerstone of antiemetic treatment. It confers antiemetic protection at high doses [3] but is associated with extrapyramidal side effects, especially in children, adolescents, and young adults [4][5][6].…”

Section: Introductionmentioning

confidence: 99%

Open-label comparison of the antiemetic efficacy of single intravenous doses of dolasetron mesylate in pediatric cancer patients receiving moderately to highly emetogenic chemotherapy

Coppes

Lau

Ingram

et al. 1999

Med. Pediatr. Oncol.

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“…Although the chemical structures of all drugs in this class are similar, the individual 5-HT 3 -receptor antagonists exhibit notable pharmacologic differences in their selectivity, potency, dose-response profiles, and half-lives [1,40,41] that may affect their activities as antiemetic agents in certain individuals. For example, pharmacologic potencies of these agents differ; the rank order of the U.S.-licensed agents is granisetron > ondansetron > dolasetron.…”

Section: A Comparable Pharmacologic Profile?mentioning

confidence: 99%

Chemotherapy-Induced Nausea and Vomiting: The Importance of Acute Antiemetic Control

Schnell¹

2003

The Oncologist

186

167

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Nausea and vomiting are two of the most feared side effects of cancer chemotherapy and radiotherapy. Chemotherapy-induced nausea and vomiting can be broadly categorized as acute (occurring within 24 hours of therapy), delayed (persisting for 6-7 days after therapy), or anticipatory (occurring prior to chemotherapy administration). Breakthrough and refractory nausea and vomiting describe the symptoms of uncontrolled emesis. Evidence suggests that good control of nausea and vomiting during the acute period correlates with the control of delayed emesis. Conversely, protection failure during the first 24 hours has a high predictive value for delayed emesis in the same cycle.The 5-HT 3 -receptor antagonists, regarded as the 'gold standard' in antiemetic therapy, are the first-line treatment for moderately and highly emetogenic chemotherapy and radiotherapy regimens in adults and children. Evidence suggests that the 5-HT 3 -receptor antagonists administered in combination with corticosteroids afford the best protection from symptoms of acute emesis and, by extrapolation, the most effective prevention of delayed emesis.Antiemetic therapeutic guidelines stress that the goal of therapy is to prevent cytostatic-induced nausea and vomiting. Therefore, the prophylactic use of the most effective antiemetic regimen-taking into consideration the emetogenicity of the chemotherapy and individual patient characteristics-must be adhered to in order to prevent acute, delayed, and anticipatory nausea and vomiting.

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“…Delayed emesis represents a significant problem and may contribute to poor overall emetic control, as well as to the possible development of anticipatory nausea and vomiting in subsequent chemotherapy cycles [93]. Although NK 1 receptors and substance P, believed to be essential components of the emetic response, have been shown to be involved in the induction of delayed emesis [94, 95], the mechanism underlying delayed symptoms is less well understood than that of acute-onset emesis.…”

Section: -Ht3-receptor Antagonists In Delayed Emesismentioning

confidence: 99%

5-HT<sub>3</sub>-Receptor Antagonists in the Management of Nausea and Vomiting in Cancer and Cancer Treatment

Aapro¹

2005

Oncology

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The 5-HT₃-receptor antagonists, considered as ‘gold standard’ therapy for cancer patients, are generally perceived to have similar efficacy and safety profiles, andmost antiemetic guidelines do not distinguish between agents. However, important pharmacological differences exist between agents, which may translate into potential benefits for some patients. In particular, 5-HT₃-receptor antagonists vary in the nature of their receptor antagonism and plasma half-lives, possibly leading to differences in duration of action. Agents with a longer duration of action provide antiemetic protection throughout the acute emetic period (24 h) with a single daily dose, whereas shorter-acting agents, e.g. ondansetron, may require multiple dosing for full efficacy. Differences also exist between agents in their hepatic metabolism and cardiovascular safety, which may present particular problems for elderly patients who often receive additional medications for comorbid conditions, increasing the risk of drug-drug interaction. Recent antiemetic guidelines from the National Comprehensive Cancer Network recommend preferential use of palonosetron for moderately emetogenic chemotherapy; however, this agent is newly approved and key clinical questions remain unanswered by clinical trial data. Selection of an appropriate 5-HT₃-receptor antagonist should be based on proven efficacy and safety, as well as on the individual characteristics of the patient.

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Reducing Chemotherapy-Induced Nausea and Vomiting Current Perspectives and Future Possibilities

Cited by 51 publications

References 87 publications

Open-label comparison of the antiemetic efficacy of single intravenous doses of dolasetron mesylate in pediatric cancer patients receiving moderately to highly emetogenic chemotherapy

Open-label comparison of the antiemetic efficacy of single intravenous doses of dolasetron mesylate in pediatric cancer patients receiving moderately to highly emetogenic chemotherapy

Chemotherapy-Induced Nausea and Vomiting: The Importance of Acute Antiemetic Control

5-HT<sub>3</sub>-Receptor Antagonists in the Management of Nausea and Vomiting in Cancer and Cancer Treatment

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