title: Prevention of emesis from multiple-day and high-dose chemotherapy regimens.
abstract: The prevention of chemotherapy-induced nausea and vomiting (CINV) has improved significantly with the introduction of the 5-hydroxytryptamine type 3 (5-HT3) receptor antagonists combined with dexamethasone. Most studies have reported on patients undergoing single-day highly or moderately emetogenic chemotherapy. There have been fewer studies and much less success in preventing CINV in patients undergoing multiple-day chemotherapy or high-dose chemotherapy with stem cell transplant. Current practice guidelines suggest the use of a first-generation 5-HT3 receptor antagonist and dexamethasone daily for each day of the multiple-day chemotherapy regimens. This practice seems to control acute CINV, but delayed CINV remains poorly controlled with a complete response (e.g., no emesis, no rescue) of less than 50% in most studies. Three new agents-palonosetron, aprepitant, and olanzapine-have shown high efficacy in preventing acute and delayed CINV in patients undergoing single-day chemotherapy. These agents have high potential for preventing CINV in patients undergoing multiple-day chemotherapy. This article proposes recommendations for their use in clinical trials and in practice.
authors.affiliation: Indiana University School of Medicine South Bend, and the Notre Dame Cancer Institute, University of Notre Dame, South Bend, IN 46617, USA. navari.1@nd.edu
authors.forename: Rudolph M
authors.initials: RM
authors.lastname: Navari
mesh_terms: D000932:Antiemetics / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D001569:Benzodiazepines / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D006801:Humans; D007546:Isoquinolines / Q000627:therapeutic use; D008787:Metoclopramide / Q000627:therapeutic use; D064729:Neurokinin-1 Receptor Antagonists; D000077152:Olanzapine; D000077924:Palonosetron; D011812:Quinuclidines / Q000627:therapeutic use; D058831:Serotonin 5-HT3 Receptor Antagonists; D012702:Serotonin Antagonists / Q000627:therapeutic use*; D014839:Vomiting / Q000139:chemically induced / Q000517:prevention & control*
chemical_list: D000932:Antiemetics; D000970:Antineoplastic Agents; D007546:Isoquinolines; D064729:Neurokinin-1 Receptor Antagonists; D011812:Quinuclidines; D058831:Serotonin 5-HT3 Receptor Antagonists; D012702:Serotonin Antagonists; D001569:Benzodiazepines; D000077924:Palonosetron; D008787:Metoclopramide; D000077152:Olanzapine