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 .
Dexamethasone, granisetron, or both for the prevention of nausea and vomiting during chemotherapy for cancer.
BACKGROUND Serotonin-receptor antagonists seem to be as effective as corticosteroids in preventing emesis induced by moderately emetogenic antineoplastic agents . We compared the antiemetic effect of a combination of granisetron and dexamethasone with that of granisetron or dexamethasone administered alone . METHODS From December 1992 to January 1994 , 482 consecutive patients who were to receive moderately emetogenic chemotherapy for the first time ( 600 to 1000 mg of cyclophosphamide per square meter of body-surface area , > or = 50 mg of doxorubicin per square meter , > or = 75 mg of epirubicin per square meter , or > or = 300 mg of carboplatin per square meter , alone or in some combination )  were enrolled in a double-blind , r and omized , multi-center study evaluating the efficacy and toxicity of three antiemetic regimens . The following antiemetic regimens were used : 8 mg of dexamethasone given intravenously before chemotherapy plus 4 mg given orally immediately before chemotherapy and then every six hours for a total of four doses , 3 mg of granisetron given intravenously before chemotherapy , or a combination of granisetron and dexamethasone given in the doses used for the single-drug regimens . RESULTS We evaluated 408 patients ( 136 receiving dexamethasone , 137 receiving granisetron , and 135 receiving both drugs ) . In the first 24 hours after chemotherapy , complete protection from vomiting and complete protection from nausea were achieved in 70.6 and 55.1 percent , respectively , of the patients receiving dexamethasone , in 72.3 and 48.2 percent of those receiving granisetron , and in 92.6 and 71.9 percent of those receiving granisetron combined with dexamethasone ( P < 0.001 for all comparisons ) . Patients who received granisetron alone had less protection from delayed vomiting and nausea than those who received dexamethasone alone or the two drugs combined . All the regimens were equally well tolerated . CONCLUSION Granisetron combined with dexamethasone was the most effective regimen for the prevention of emesis induced by moderately emetogenic chemotherapy
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 .