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 .
The delayed-emesis syndrome from cisplatin: phase III evaluation of ondansetron versus placebo.
Cisplatin may evoke both an acute emetic response during the first 24 hours following treatment and a less well-recognized syndrome of delayed emesis . While delayed emesis is usually less severe in terms of frequency of vomiting episodes , the problem continues to result in significant morbidity . In comparison with acute emesis , the exact pathogenesis of the delayed emesis syndrome remains unclear . Although a combination of oral metoclopramide and dexamethasone is effective in many patients in preventing delayed emesis , almost 50 % continue to experience at least one emetic episode when treated with this regimen . A phase III multicenter study has evaluated oral ondansetron versus placebo in the prevention of the  delayed-emesis syndrome in 50 patients during days 2 through 5 following high-dose cisplatin administration . Although the daily rates of complete emetic control , failure , and control of nausea favor ondansetron , this trial is statistically inconclusive in establishing efficacy of ondansetron as a single agent in the prevention of delayed emesis .  Ondansetron was well tolerated in the dose and schedule used
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 .