title: Tropisetron and dexamethasone administered twice daily for the prevention of acute emesis in patients treated with continuous infusion of Cisplatin-Doxorubicin and high-dose Ifosfamide over 48, 24, and 120 hours.
abstract: The antiemetic effectiveness of 5-HT3 receptor antagonists in combination with dexamethasone in patients receiving short-term infusion chemotherapy has been well demonstrated. Less information is available about the efficacy of the same antiemetic combination in patients treated with regimens of chemotherapy in which the drugs are delivered in continuous infusion of several hours. The purpose of this study was to report the effectiveness of a double administration of antiemetic drugs in patients treated with strong emesis-inducing drugs for several days. In this study, 19 male and 13 female patients with osteosarcoma, ages 9 to 45 years, treated with chemotherapy, received intravenous tropisetron 5 mg plus dexamethasone 8 mg every 12 hours during the first two cycles of the preoperative treatment: cisplatin 120 mg/m2 over 48 hours followed by Adriamycin 75 mg/m2 delivered in 24 hours and continuous infusion of ifosfamide 15 g/m2 over 120 hours. The assessment of the antiemetic efficacy was performed three times every day: from 8:00 am to 4:00 pm, from 4:00 pm to 12:00 am, and from 12:00 am to 8:00 am. The patients were followed from the beginning of the treatment until 2 hours after its end, when they were discharged from hospital. Complete protection from emesis was obtained in 80% of the 256 days of treatment: 81% during the first cycle (cisplatin 120 mg/m2 in 48 hours followed by Adriamycin 75 mg/m2 delivered in 24 hours) and 79% during the second cycle (continuous infusion of ifosfamide 15 g/m2 in 120 hours). In both cycles, complete protection declined from the first to the last day of treatment (from 100% to 62% during the first cycle and from 100% to 63% during the second cycle). These results indicate that when chemotherapy is administered in a protracted infusion, higher doses of antiemetic agents are necessary to achieve acceptable antiemetic activity.
authors.affiliation: Service of Chemotherapy, Department of Musculoskeletal Oncology, Rizzoli Orthopedic Institute, Via Pupilli 1, 40136 Bologna, Italy. cristiana.forni@ior.it
authors.forename: Cristiana
authors.initials: C
authors.lastname: Forni
authors.forename: Loretta
authors.initials: L
authors.lastname: Loro
authors.forename: Teresa
authors.initials: T
authors.lastname: Mazzei
authors.forename: Claudio
authors.initials: C
authors.lastname: Beghelli
authors.forename: Angela
authors.initials: A
authors.lastname: Biolchini
authors.forename: Morena
authors.initials: M
authors.lastname: Tremosini
authors.forename: Antonietta
authors.initials: A
authors.lastname: Triggiani
authors.forename: Gaetano
authors.initials: G
authors.lastname: Bacci
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000932:Antiemetics / Q000627:therapeutic use*; D018906:Antineoplastic Agents, Alkylating / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects*; D002648:Child; D002945:Cisplatin / Q000008:administration & dosage; D003907:Dexamethasone / Q000627:therapeutic use*; D004317:Doxorubicin / Q000008:administration & dosage; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007069:Ifosfamide / Q000008:administration & dosage; D007211:Indoles / Q000627:therapeutic use*; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D012516:Osteosarcoma / Q000188:drug therapy; D012702:Serotonin Antagonists / Q000627:therapeutic use*; D013997:Time Factors; D016896:Treatment Outcome; D000077526:Tropisetron; D014839:Vomiting / Q000139:chemically induced* / Q000517:prevention & control*
chemical_list: D000932:Antiemetics; D018906:Antineoplastic Agents, Alkylating; D007211:Indoles; D012702:Serotonin Antagonists; D000077526:Tropisetron; D003907:Dexamethasone; D004317:Doxorubicin; D002945:Cisplatin; D007069:Ifosfamide