Treatment of chemotherapy-induced emesis in the 1990s: impact of the 5-HT3 receptor antagonists.
Considerable progress has been made in the development of means to limit nausea and vomiting arising from cancer chemotherapy. A number of key conceptual advances in the last decade have been critically important. these include recognition of the value of combination antiemetic therapy, identification of important patient- and treatment-related factors predictive of emesis, and appreciation of the importance of serotonin (5-HT) in the pathophysiology of emesis and the value of selective antagonists of the type-3 serotonin receptor. Comparative trials of the 5-HT3 receptor antagonists and classic antiemetic agents have helped define optimal antiemetic approaches in a number of settings. A combination of a 5-HT3 antagonist and dexamethasone is the treatment of choice for patients receiving single- and multiple-day cisplatin. The 5-HT3 antagonists are also effective agents with noncisplatin chemotherapy. Clear-cut superiority to classic antiemetics such as dexamethasone has not been consistently demonstrated, however. Results with the 5-HT3 antagonists in cisplatin-induced delayed emesis have been disappointing to date. The results of ongoing prospective trials should define their role more clearly. At present a combination of metoclopramide and dexamethasone is the treatment of choice in this setting. Results of trials comparing 5-HT3 antagonists are beginning to emerge. Available information suggests no clinically relevant differences in antiemetic efficacy between these agents. Many questions regarding the optimal use of the 5-HT3 antagonists and their integration into clinical practice remain unanswered and are the appropriate focus for additional study.
Hesketh
P J
PJ
Division of Hematology and Oncology, St. Elizabeth's Medical Center of Boston, MA 02135.
D000932:Antiemetics / Q000008:administration & dosage / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000009:adverse effects*; D002945:Cisplatin / Q000009:adverse effects; D003907:Dexamethasone / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D008787:Metoclopramide / Q000008:administration & dosage / Q000627:therapeutic use; D009325:Nausea / Q000139:chemically induced / Q000503:physiopathology / Q000517:prevention & control; D009369:Neoplasms / Q000188:drug therapy*; D011446:Prospective Studies; D012701:Serotonin / Q000502:physiology; D012702:Serotonin Antagonists / Q000008:administration & dosage / Q000627:therapeutic use*; D014839:Vomiting / Q000139:chemically induced / Q000503:physiopathology / Q000517:prevention & control*
D000932:Antiemetics; D000970:Antineoplastic Agents; D012702:Serotonin Antagonists; D012701:Serotonin; D003907:Dexamethasone; D008787:Metoclopramide; D002945:Cisplatin