[New developments in the treatment of nausea and vomiting caused by chemotherapy].
With the advent of the 5HT3-receptor antagonists in the 1990s and their combination with dexamethasone, complete emesis protection during the first 24 hours after administration of an emetogenic cytostatic agent became possible in 70% of the patients. Despite acute emesis protection through the use of 5HT3-receptor antagonists and dexamethasone, 40% of the patients do have symptoms during the following days. 5HT3-receptor antagonists and dexamethasone are modestly effective in this delayed phase and the antiemetic protection decreases progressively with multiple cycles. Neurokinine(NK)-1-receptor antagonists belong to a new class of antiemetic agents that specifically target the NK-1-receptor which is involved in both the acute, and in particular, the delayed phase. Clinical studies have demonstrated that the addition of the NK-1-receptor antagonist apprepitant to a 5HT3-receptor antagonist plus dexamethasone combination improves acute emesis protection by about 20% (from approximately 60% to 80%) and by about 30-40% in the delayed phase (from approximately 30% to 60-70%). The effectiveness of this triple therapy is sustained during subsequent cycles. The chance that an individual patient will be completely protected from severe nausea and vomiting during the entire course of chemotherapy (often 6 cycles) consequently increases significantly (from 34% in the placebo group to 59% in the aprepitant group).
de Wit
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Erasmus Medisch Centrum, locatie Daniel den Hoed Kliniek, afd. Interne Oncologie, Postbus 5201, 3008 AE Rotterdam. r.dewit@erasmusmc.nl
van Alphen
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D000932:Antiemetics / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000009:adverse effects*; D003907:Dexamethasone / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D006801:Humans; D009325:Nausea / Q000139:chemically induced / Q000188:drug therapy*; D064729:Neurokinin-1 Receptor Antagonists; D012702:Serotonin Antagonists / Q000627:therapeutic use*; D013997:Time Factors; D014839:Vomiting / Q000139:chemically induced / Q000188:drug therapy*
D000932:Antiemetics; D000970:Antineoplastic Agents; D064729:Neurokinin-1 Receptor Antagonists; D012702:Serotonin Antagonists; D003907:Dexamethasone