Contribution to the treatment of nausea and emesis induced by chemotherapy in children and adolescents with osteosarcoma.
OBJECTIVE
Chemotherapy-induced emesis is a limiting factor in treating children with malignancies. Intensive chemotherapy regimens along with emetogenic drug administration have increased the frequency and severity of emesis and nausea. Our study was designed to consider the importance of this problem and the need for improvement in emesis treatment for patients receiving chemotherapy. Our objective was to compare the efficacy and safety of the antiemetic drug granisetron and a regimen of metoclopramide plus dimenhydrinate.


METHODS
Open, prospective and randomized study at Instituto de Oncologia Pediátrica, Department of Pediatrics, Universidade Federal de São Paulo.


METHODS
From February to August 1994, 26 patients (mean age: 14 years) with osteosarcoma received 80 chemotherapy cycles of iphosphamide (2,500 mg/m2) plus epirubicin (75 mg/m2) or carboplatin (600 mg/m2), or epirubicin (75 mg/m2) plus carboplatin (600 mg/m2). Eighty chemotherapy treatments were analyzed regarding nausea and vomiting control. Patients were randomized to receive either a single dose of granisetron (50 microg/kg) or metoclopramide (2 mg/kg) plus dimenhydrinate (5 mg/kg infused over eight hours). Emesis and nausea were monitored for 24 hours by means of the modified Morrow Assessment of Nausea and Emesis. Statistical analysis utilized the chi-squared, Student t and Mann-Whitney tests, plus data exploration techniques.


RESULTS
62.5% of the patients undergoing chemotherapy responded completely to granisetron, whereas 10% responded to metoclopramide plus dimenhydrinate (p < 0.0001). No severe adverse reactions were found in either of the treatments given.


CONCLUSIONS
In children and adolescents with osteosarcoma, granisetron was safe and more efficient than metoclopramide plus dimenhydrinate for controlling chemotherapy-induced emesis and nausea.
Luisi
Flavio Augusto Vercillo
FA
Pediatrics Oncology Section, Department of Pediatrics, Universidade Federal de São Paulo-Escola Paulista de Medicina, São Paulo, Brazil. luisi@osite.com.br
Petrilli
Antônio Sérgio
AS
Tanaka
Cristiana
C
Caran
Eliana Maria Monteiro
EM
D000293:Adolescent; D000932:Antiemetics / Q000008:administration & dosage*; D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001859:Bone Neoplasms / Q000188:drug therapy; D002648:Child; D004111:Dimenhydrinate / Q000008:administration & dosage; D005260:Female; D017829:Granisetron / Q000008:administration & dosage; D006801:Humans; D008297:Male; D008787:Metoclopramide / Q000008:administration & dosage; D009325:Nausea / Q000139:chemically induced / Q000517:prevention & control*; D012516:Osteosarcoma / Q000188:drug therapy; D011446:Prospective Studies; D014839:Vomiting / Q000139:chemically induced / Q000517:prevention & control*
D000932:Antiemetics; D000970:Antineoplastic Agents; D004111:Dimenhydrinate; D017829:Granisetron; D008787:Metoclopramide