Consensus proposals for the prevention of acute and delayed vomiting and nausea following high-emetic-risk chemotherapy.
This paper uses an evidence-based approach whenever possible to formulate recommendations, emphasizing the results of controlled trials concerning the best use of antiemetic agents. We address issues of dose, schedule, and route of administration of five selective 5-HT(3) antagonists. We conclude that for each of these five drugs, there is a plateau in therapeutic efficacy above which further dose escalation does not improve outcome. Furthermore, for all classes of antiemetic agents, a single dose is as effective as multiple doses or a continuous infusion. The oral route is as efficacious as the intravenous route of administration, even with chemotherapy of high emetic risk. Selective antagonists of the type 3 serotonin receptor (5-HT(3)) in combination with dexamethasone and aprepitant are the standard of care for the prevention of emesis following chemotherapy of high emetic risk.
Kris
Mark G
MG
Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA. krism@mskcc.org
Hesketh
Paul J
PJ
Herrstedt
Jorn
J
Rittenberg
Cynthia
C
Einhorn
Lawrence H
LH
Grunberg
Steven
S
Koeller
Jim
J
Olver
Ian
I
Borjeson
Sussanne
S
Ballatori
Enzo
E
D000932:Antiemetics / Q000008:administration & dosage / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000009:adverse effects*; D002986:Clinical Trials as Topic; D032921:Consensus; D003907:Dexamethasone / Q000627:therapeutic use; D004333:Drug Administration Routes; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D019317:Evidence-Based Medicine; D006801:Humans; D009325:Nausea / Q000139:chemically induced / Q000517:prevention & control*; D064729:Neurokinin-1 Receptor Antagonists; D017410:Practice Guidelines as Topic; D058831:Serotonin 5-HT3 Receptor Antagonists; D014839:Vomiting / Q000139:chemically induced / Q000517:prevention & control*
D000932:Antiemetics; D000970:Antineoplastic Agents; D064729:Neurokinin-1 Receptor Antagonists; D058831:Serotonin 5-HT3 Receptor Antagonists; D003907:Dexamethasone