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 oral neurokinin-1 antagonist aprepitant for the prevention of chemotherapy-induced nausea and vomiting: a multinational, randomized, double-blind, placebo-controlled trial in patients receiving high-dose cisplatin--the Aprepitant Protocol 052 Study Group.
PURPOSE In early clinical trials with patients receiving highly emetogenic chemotherapy , the neurokinin antagonist aprepitant significantly enhanced the efficacy of a st and ard antiemetic regimen consisting of a type-three 5-hydroxytryptamine antagonist and a corticosteroid . This multicenter , r and omized , double-blind , placebo-controlled phase III study was performed to establish definitively the superiority of the aprepitant regimen versus st and ard therapy in the prevention of chemotherapy-induced nausea and vomiting ( CINV ) . PATIENTS AND METHODS Patients receiving cisplatin > or = 70 mg/m2 for the first time were given either st and ard therapy ( ondansetron and dexamethasone on day 1 ; dexamethasone on days 2 to 4 ) or an aprepitant regimen ( aprepitant plus ondansetron and dexamethasone on day 1 ; aprepitant and dexamethasone on days 2 to 3 ; dexamethasone on day 4 ) . Patients recorded nausea and vomiting episodes in a diary . The primary end point was complete response ( no emesis and no rescue therapy ) on days 1 to 5 postcisplatin , analyzed by a modified intent-to-treat approach . Treatment comparisons were made using logistic regression models . Tolerability was assessed by reported adverse events and physical and laboratory assessment s. RESULTS The percentage of patients with complete response on days 1 to 5 was significantly higher in the aprepitant group ( 72.7 % [ n = 260 ] v 52.3 % in the st and ard therapy group [ n = 260 ] ) , as were the percentages on day 1 , and especially on days 2 to 5 ( P < .001 for all three comparisons ) . CONCLUSION Compared with st and ard dual therapy , addition of aprepitant was generally well tolerated and provided consistently superior protection against CINV in patients receiving highly emetogenic cisplatin-based 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 .