For persons receiving chemotherapy of high emetic risk , there is no group of patients for whom agents of lower therapeutic index are appropriate first-choice antiemetics .
In all patients receiving cisplatin and all other agents of high emetic risk , the two-drug combination of dexamethasone and aprepitant is recommended for the prevention of delayed emesis .
The Up date Committee no longer recommends the combination of a 5-HT3 serotonin receptor antagonist and dexamethasone for the prevention of delayed emesis after chemotherapeutic agents of high emetic risk .
PURPOSE To up date the 1999 American Society of Clinical Oncology guideline for antiemetics in oncology .
Phase III double-blind comparison of dolasetron mesylate and ondansetron and an evaluation of the additive role of dexamethasone in the prevention of acute and delayed nausea and vomiting due to moderately emetogenic chemotherapy.
PURPOSE To compare the efficacy of dolasetron and ondansetron in controlling nausea and vomiting in the first 24 hours ; to evaluate the efficacy when dexamethasone is added to either drug in the first 24 hours ; and to extend these comparisons over 7 days in patients receiving moderately emetogenic chemotherapy . PATIENTS AND METHODS This was a multicenter , double-blind , r and omized study with six parallel arms that used a 2 x 2 factorial design in chemotherapy-naive patients . In arm 1 , dolasetron ( 2.4 mg/kg ) was given intravenously ( I.V. ) prechemotherapy , followed 24 hours later by oral dolasetron ( 200 mg once daily ) for 6 days . Arms 2 and 3 consisted of dolasetron and dexamethasone 8 mg I.V. , followed 24 hours later by oral dexamethasone ( 8 mg once daily ) in one arm , and oral dexamethasone and dolasetron in the other , also for 6 days . In arms 4 , 5 , and 6 , ondansetron ( 32 mg I.V. or 8 mg orally twice daily ) was administered in a similar manner to arms 1 , 2 , and 3 before and 24 hours after chemotherapy .  Mean nausea severity ( MNS ) was assessed on a visual analog scale ( VAS ) in a daily diary . RESULTS Of 703 patients enrolled , 696 were eligible . There were 343 dolasetron- and 353 ondansetron-treated patients ; 57 % of dolasetron-treated patients had complete protection in the first 24 hours versus 67 % of patients who received ondansetron ( P = .013 ) . MNS was also more pronounced on the dolasetron arm ( P = .051 ) . Sixty-seven percent of patients who received added dexamethasone in the first 24 hours had complete protection , compared with 55 % without dexamethasone ( P < .001 ) . MNS was significantly reduced with the addition of dexamethasone ( P < .001 ) . At 7 days , dolasetron and ondansetron had equivalent complete protection rates ( 36 % and 39 % , respectively ) . With the addition of dexamethasone , 48 % of patients compared with 28 % had complete protection ( P < .001 ) . MNS was significantly improved with added dexamethasone ( P < .001 ) . CONCLUSION At the doses used , dolasetron was significantly less effective than ondansetron at controlling nausea and vomiting in the first 24 hours in patients receiving moderately emetogenic chemotherapy , but there was no demonstrable difference between both drugs over 7 days . The addition of dexamethasone significantly improved the efficacy of both drugs in the first 24 hours and over 7 days
For persons receiving chemotherapy of high emetic risk , there is no group of patients for whom agents of lower therapeutic index are appropriate first-choice antiemetics .
In all patients receiving cisplatin and all other agents of high emetic risk , the two-drug combination of dexamethasone and aprepitant is recommended for the prevention of delayed emesis .
The Up date Committee no longer recommends the combination of a 5-HT3 serotonin receptor antagonist and dexamethasone for the prevention of delayed emesis after chemotherapeutic agents of high emetic risk .
PURPOSE To up date the 1999 American Society of Clinical Oncology guideline for antiemetics in oncology .