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 .
Palonosetron improves prevention of chemotherapy-induced nausea and vomiting following moderately emetogenic chemotherapy: results of a double-blind randomized phase III trial comparing single doses of palonosetron with ondansetron.
BACKGROUND Although all first-generation 5-HT(3 ) receptor antagonists demonstrate efficacy in preventing acute chemotherapy-induced nausea and vomiting ( CINV ) , effective prevention of delayed CINV has not yet been achieved . This study compared the efficacy and tolerability of palonosetron , a novel , second-generation 5-HT(3 ) receptor antagonist , with ondansetron . PATIENTS AND METHODS In this multicenter , r and omized , double-blind , stratified , phase III study , 570 adult cancer patients were r and omized to receive a single i.v . dose of palonosetron 0.25 mg , palonosetron 0.75 mg or ondansetron 32 mg , each administered 30 min before initiation of moderately emetogenic chemotherapy . The primary end point was the proportion of patients with no emetic episodes and no rescue medication [ complete response ( CR ) ] during the 24 h after chemotherapy administration ( acute period ) . Secondary end points included efficacy in treatment of delayed CINV ( < /=5 days post-chemotherapy ) and overall tolerability . RESULTS 563 patients were evaluable for efficacy .  CR rates were significantly higher ( P < 0.01 ) for palonosetron 0.25 mg than ondansetron during the acute ( 0 - 24 h ) ( 81.0 % versus 68.6 % , respectively ) , delayed ( 24 - 120 h ) ( 74.1 % versus 55.1 % ) and overall ( 0 - 120 h ) ( 69.3 % versus 50.3 % ) periods . CR rates achieved with palonosetron 0.75 mg were numerically higher but not statistically different from ondansetron during all three time intervals . Both treatments were well tolerated . CONCLUSIONS A single i.v . dose of palonosetron 0.25 mg was significantly superior to i.v . ondansetron 32 mg in the prevention of acute and delayed CINV
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 .