Prophylaxis is recommended. In clinical studies of the weekly dosage schedule, the majority of patients received dexamethasone 10 mg given in conjunction with a 5-HT 3 blocker such as ondansetron or granisetron. One antiemetic agent commonly used with antineoplastic agents is prochlorperazine, which can cause akathisia. Even when they are given on the same day, however, the incidence of akathisia remains in the range reported with premedication of prochlorperazine with other chemotherapies. Deaths due to sepsis following severe myelosuppression have been reported.
Serious thrombocytopenia is uncommon.
The routine use of CSF is not necessary. Grade 3 or 4 neutropenia concomitant with grade 3 or 4 late diarrhea should be treated aggressively with IV hydration, loperamide, and oral antibiotics. The incidence of grade 3 or 4 neutropenia does not vary significantly with age or gender. Patients 65 years of age or older or those with a low WHO performance status were more likely to experience grade 3 or 4 late diarrhea. Women of childbearing potential should be advised to avoid becoming pregnant and that nursing be discontinued when receiving therapy.