Anthropometric and pharmacotherapeutic variables on acute emesis induced by cisplatin-containing chemotherapy.
OBJECTIVE
To characterize the effects of anthropometric and pharmacotherapeutic variables on acute emesis induced by cisplatin-containing regimens with dosages > or =50 mg x m(-2).


METHODS
A prospective, cross-sectional, noncontrolled study was performed to analyze acute vomiting during the first 24 hours in patients treated in a Spanish hospital. The patients received an intravenous combination of drugs (2 doses of metoclopramide 3 mg/kg, dexamethasone 20 mg) as first-choice antiemetic therapy. Intravenous ondansetron 8 mg and dexamethasone 20 mg served as an alternative regimen in patients <30 years old with a history of extrapyramidal manifestations or emesis in previous cycles. Therapeutic failure was used as a dependent variable, defined as three or more vomiting episodes documented by the patients. Other variables were the chemotherapeutic regimen; antiemetic regimen; patient gender, age, weight, and height; and cycle number. The reference logistic model and two reduced-models derived from the latter were designed. The logistic models were subsequently validated by means of receiving operating characteristic curves.


RESULTS
A total of 319 cycles involving 106 patients were studied. The metoclopramide regimen was administered in 66% of the cycles. The therapeutic failure rate was 21% for the metoclopramide regimen and 32% for the ondansetron treatment. The logistic model developed identified the type of chemotherapeutic regimen provided as the most significant prognostic variable (p < 0.0001). Patient weight (odds ratio 1.64) and height (odds ratio 1.28) were identified as prognostic factors related with therapeutic failure.


CONCLUSIONS
The type of chemotherapeutic regimen administered and the anthropometric characteristics of the patients exert a clear conditioning effect on risks associated with therapeutic failure against acute emesis following high-dose cisplatin therapy. Such anthropometric parameters have not been previously identified as prognostic factors.
Catalán Arlandis
J L
JL
Servicio Especial de Urgencias, Valencia, Spain. catalan_jlu@gva.es
Jiménez Torres
N V
NV
D000208:Acute Disease; D000367:Age Factors; D000932:Antiemetics / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000009:adverse effects*; D001837:Body Weights and Measures; D002746:Chlorpromazine / Q000627:therapeutic use*; D002945:Cisplatin / Q000009:adverse effects*; D003430:Cross-Sectional Studies; D003907:Dexamethasone / Q000627:therapeutic use*; D004338:Drug Combinations; D006801:Humans; D016015:Logistic Models; D008787:Metoclopramide / Q000627:therapeutic use*; D008875:Middle Aged; D015999:Multivariate Analysis; D017294:Ondansetron / Q000627:therapeutic use; D009966:Orphenadrine / Q000627:therapeutic use*; D011379:Prognosis; D011446:Prospective Studies; D012737:Sex Factors; D014839:Vomiting / Q000139:chemically induced* / Q000517:prevention & control
D000932:Antiemetics; D000970:Antineoplastic Agents; D004338:Drug Combinations; C050340:chlorpromazine, dexamethasone, metoclopramide, orphenadrine drug combination; D017294:Ondansetron; D003907:Dexamethasone; D009966:Orphenadrine; D008787:Metoclopramide; D002945:Cisplatin; D002746:Chlorpromazine