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 .
Ondansetron compared with high-dose metoclopramide in prophylaxis of acute and delayed cisplatin-induced nausea and vomiting. A multicenter, randomized, double-blind, crossover study.
OBJECTIVE To compare the efficacy and side effects of ondansetron with those of high-dose metoclopramide in treating acute and delayed cisplatin-induced nausea and vomiting .  DESIGN R and omized , double-blind , crossover trial . SETTING Conducted at two university hospitals , a cancer institute , and six community hospitals . PATIENTS Of 125 patients , 95 were evaluable for the acute phase and 79 for the delayed phase . Major reasons for not being evaluable were no second course ( 14 patients ) , protocol violation ( 5 patients ) , and change in cisplatin dose ( 3 patients ) for the acute phase , and rescue medication on day 1 ( 7 patients ) , protocol violation ( 3 patients ) , and inadequate data ( 4 patients ) for the delayed phase . INTERVENTIONS All patients received cisplatin , 50 to 100 mg/m2 body surface area ( median , 75 mg/m2 ) ; none had previously received chemotherapy .  Thirty minutes before the cisplatin administration , ondansetron was given intravenously over 15 minutes , at a loading dose of 8 mg followed by a continuous infusion of 1 mg/h for 24 hours . Metoclopramide was given at a loading dose of 3 mg/kg body weight , followed by a continuous infusion for 8 hours ( 4 mg/kg ) . For the delayed phase ( days 2 through 6 ) , the first oral dose was given as soon as the infusion was completed ; the oral dose consisted of either metoclopramide , 20 mg three times daily , or ondansetron , 8 mg three times daily for another 5 days . MEASUREMENTS AND MAIN RESULTS In the acute phase , a major or complete response was seen in 72 % of the ondansetron-treated and 41 % of the metoclopramide-treated patients ( P less than 0.001 ) . Nausea was significantly better controlled among the ondansetron-treated patients ( P = 0.04 ) . In the delayed phase , no statistically significant difference was seen between ondansetron- and metoclopramide-treated patients . Nausea was significantly better controlled with metoclopramide ( P = 0.016 ) . CONCLUSIONS Ondansetron is significantly more effective than metoclopramide in preventing acute nausea and vomiting . In the delayed phase , the results of both drugs were disappointing , although metoclopramide 's effect on delayed nausea was superior . Patients preferred ondansetron
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 .