Should 5-Hydroxytryptamine-3 Receptor Antagonists Be Administered Beyond 24 Hours After Chemotherapy to Prevent Delayed Emesis? Systematic Re-Evaluation of Clinical Evidence and Drug Cost Implications

Abstract

Neither clinical evidence nor considerations of cost effectiveness justify using 5-HT(3) antagonists beyond 24 hours after chemotherapy for prevention of delayed emesis.

Guidelines for Antiemetic Treatment of Chemotherapy-Induced Nausea and Vomiting: Past, Present, and Future Recommendations

“…As discussed before, the NCCN guidelines suggest aprepitant with or without dexamethasone in this situation. A 5-HT 3 RA can be used as an alternative, although their therapeutic role in the delayed phase is rather limited [26]. In contrast to all three previously published guidelines, metoclopramide is not reflected in the new guidelines as an alternative option (see above).…”

Corticosteroids, the oldest agent in the prevention of chemotherapy-induced nausea and vomiting: What about the guidelines?

“…The effect of setrons on delayed CINV is minimal and this has led to the search for new drugs. [9,10] Palonosetron has a hundred times higher binding affinity and a longer elimination half-life (40 hours). It has an equal effect in comparison to the other setrons on acute emesis but seems to be superior in delayed emesis of moderate emetogenic chemotherapy (MEC).…”

Doxorubicin and Dacarbazine (AD) Regimen for Soft Tissue Sarcomas

“…A meta-analysis of several trials of serotonin antagonists recommends against prolonged (greater than 24 hours) use of these agents, making a steroid, or steroid and dopamine antagonist combination, most appropriate for follow-up therapy. 10 One of the following regimens is recommended: 1. Dexamethasone 4 mg PO twice a day for 3 days ± metoclopramide 0.5 to 2 mg/kg PO every 4 to 6 hours ± diphenhydramine 25 to 50 mg PO every 6 hours if needed for restlessness, starting on day 5 of AD.…”