Optimizing antiemetic therapy in multiple-day and multiple cycles of chemotherapy.
OBJECTIVE
Only a few studies have investigated the effect of antiemetic therapy in patients treated with multiple-day or multiple cycles of chemotherapy. The present review will assess the available data, highlight the current recommendations and draw attention towards the remaining problems in this field of antiemetic treatment.


RESULTS
Evidence-based guidelines recommend a combination of a 5-HT3-receptor antagonist and dexamethasone in the prophylaxis of nausea and vomiting in multiple-day cisplatin-based chemotherapy. In patients treated with multiple cycles of chemotherapy the addition of a NK1-receptor antagonist aprepitant to standard antiemetic therapy has increased the antiemetic effect, and multiple cycle extension studies have demonstrated that this increment in effect is sustained during multiple cycles of chemotherapy. A recent study indicated that the dopamine D2-receptor antagonist metopimazine has some additive effect on delayed symptoms induced by multiple-day chemotherapy.


CONCLUSIONS
The development of the NK1-receptor antagonist aprepitant has significantly improved the antiemetic control in patients treated with multiple cycles of chemotherapy. Far too many patients still experience considerable emetic side effects. The effect of aprepitant in multiple-day chemotherapy has yet to be defined. The effect of new antiemetic agents such as palonosetron and olanzapine also needs to be investigated in randomized trials.
Ellebaek
Eva
E
Department of Oncology R, Copenhagen University Hospital, Herlev, Denmark.
Herrstedt
Jørn
J
D000932:Antiemetics / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000009:adverse effects*; D000077608:Aprepitant; D001569:Benzodiazepines / Q000627:therapeutic use; D002945:Cisplatin / Q000009:adverse effects; D003907:Dexamethasone / Q000627:therapeutic use; D065127:Dopamine D2 Receptor Antagonists; D004334:Drug Administration Schedule; D006801:Humans; D007540:Isonipecotic Acids / Q000627:therapeutic use; D007546:Isoquinolines / Q000627:therapeutic use; D009025:Morpholines / Q000627:therapeutic use; D009325:Nausea / Q000188:drug therapy* / Q000209:etiology; 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 / Q000188:drug therapy* / Q000209:etiology
D000932:Antiemetics; D000970:Antineoplastic Agents; D065127:Dopamine D2 Receptor Antagonists; D007540:Isonipecotic Acids; D007546:Isoquinolines; D009025:Morpholines; D064729:Neurokinin-1 Receptor Antagonists; D011812:Quinuclidines; D058831:Serotonin 5-HT3 Receptor Antagonists; D012702:Serotonin Antagonists; D001569:Benzodiazepines; D000077608:Aprepitant; C005260:metopimazine; D000077924:Palonosetron; D003907:Dexamethasone; D000077152:Olanzapine; D002945:Cisplatin