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 of ondansetron (GR 38032F) and the role of serotonin in cisplatin-induced nausea and vomiting.
We compared the efficacy and safety of ondansetron ( GR 38032F ) , a selective antagonist of serotonin S3 receptors , with that of placebo in controlling the nausea and vomiting induced by cisplatin treatment in 28 patients with cancer . The patients received either three intravenous doses of ondansetron ( 0.15 mg per kilogram of body weight ) or normal saline ( placebo ) at four-hour intervals , beginning 30 minutes before the administration of cisplatin .  Nausea and vomiting were markedly diminished in the group given ondansetron . The median time to the first episode of emesis was 2.8 hours in the placebo group and 11.6 hours in the ondansetron group ( P less than 0.001 ) ; the median number of episodes in 24 hours was 5.5 in the placebo group and 1.5 in the ondansetron group ( P less than 0.001 ) ; the mean ( + /- SEM ) number of regurgitations or dry heaves per episode was 3.2 + /- 0.5 in the placebo group and 1.17 + /- 0.1 in the ondansetron group ( P less than 0.001 ) . None of the 14 patients given ondansetron , but 12 of 14 given placebo , required treatment with antiemetic-rescue agents  for the control of nausea and vomiting . There were no adverse effects attributable to ondansetron . The urinary excretion of 5-hydroxyindoleacetic acid , the main metabolite of serotonin , was increased in all patients two to six hours after they received cisplatin chemotherapy , and the increases paralleled the episodes of emesis . We conclude that ondansetron is an effective and safe agent for controlling the nausea and vomiting induced by cisplatin treatment . We suggest that cisplatin treatment increases the release of serotonin from enterochromaffin cells , and that ondansetron acts by blocking S3 receptors for serotonin
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 .