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 .
Efficacy and tolerability of aprepitant for the prevention of chemotherapy-induced nausea and vomiting in patients with breast cancer after moderately emetogenic chemotherapy.
PURPOSE This is the first study in which the NK(1)-receptor antagonist , aprepitant ( APR ) , was evaluated for the prevention of chemotherapy-induced nausea and vomiting ( CINV ) with moderately emetogenic chemotherapy . PATIENTS AND METHODS Eligible breast cancer patients were naive to emetogenic chemotherapy and treated with cyclophosphamide + /- doxorubicin or epirubicin .  Patients were r and omly assigned to either an aprepitant regimen ( day 1 , APR 125 mg , ondansetron ( OND ) 8 mg , and dexamethasone 12 mg before chemotherapy and OND 8 mg 8 hours later ; days 2 through 3 , APR 80 qd ) [ DOSAGE ERROR CORRECTED ] or a control regimen ( day 1 , OND 8 mg and dexamethasone 20 mg before chemotherapy and OND 8 mg 8 hours later ; days 2 through 3 , OND 8 mg bid ) . Data on nausea , vomiting , and use of rescue medication were collected with a self-report diary . The primary efficacy end point was the proportion of patients with complete response , defined as no vomiting and no use of rescue therapy , during 120 hours after initiation of chemotherapy in cycle 1 . The secondary end point was the proportion of patients with an average item score higher than 6 of 7 on the Functional Living Index-Emesis question naire . RESULTS Of 866 patients r and omized , 857 patients ( 99 % ) were assessable .  Overall complete response was greater with the aprepitant regimen than with the control regimen ( 50.8 % v 42.5 % ; P = .015 ) . More patients in the aprepitant group reported minimal or no impact of CINV on daily life ( 63.5 % v 55.6 % ; P = .019 ) . Both treatments were generally well tolerated . CONCLUSION The aprepitant regimen was more effective than the control regimen for prevention of CINV in patients receiving both an anthracycline and cyclophosphamide
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 .