title: Prospective evaluation of the incidence of delayed nausea and vomiting in patients with colorectal cancer receiving oxaliplatin-based chemotherapy.
abstract: OBJECTIVE
  This study sought to prospectively determine the frequency of delayed nausea and vomiting with oxaliplatin-based chemotherapy following day 1 prophylaxis with a 5-HT-(3) receptor antagonist and dexamethasone.
  
  
  METHODS
  Patients with colon cancer, ≥ age 18, with a performance status ≤ 2, receiving oxaliplatin (85-100 mg/m(2)) as part of a standard folinic acid, 5-fluorouracil, oxaliplatin regimen for the first time were eligible. All patients received a 5-HT(3) receptor antagonist and dexamethasone 20 mg on day 1 prior to oxaliplatin. No routine prophylaxis for delayed emesis was given. Antiemetic outcome was recorded in patient-completed diaries for the 120-h study period following oxaliplatin administration. Primary endpoint was frequency of delayed (24-120 h) emesis (vomiting/retching).
  
  
  RESULTS
  Forty-one patients were enrolled and 39 are evaluable. Median age was 70 (34-85) and the female/male ratio was 20:19. Four patients (10%) experienced vomiting or retching during the delayed period. One patient vomited during the first 24 h after oxaliplatin. The overall (120 h) no emesis rate was 87% (34/39). Twenty-one patients (54%) developed delayed nausea. Nine patients had moderate or severe nausea. Eighteen patients (46%) took rescue antiemetics during the delayed period. Delayed and overall complete response (no emesis or use of rescue antiemetics) rates were 54% and 49%, respectively.
  
  
  CONCLUSIONS
  The use of a 5-HT(3) antagonist and dexamethasone prior to oxaliplatin results in excellent control of nausea and vomiting (CR-90%) during the 24 h after chemotherapy. However, without further antiemetic treatment, complete response in the delayed period decreased to 54%. This study supports the need for routine antiemetic prophylaxis for delayed nausea and vomiting following oxaliplatin-based chemotherapy.
authors.affiliation: Department of Hematology and Oncology, Lahey Clinic Medical Center, 41 Mall Road, Burlington, MA 01805, USA. Paul.Hesketh@lahey.org
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Hesketh
authors.forename: Pedro
authors.initials: P
authors.lastname: Sanz-Altamira
authors.forename: Julie
authors.initials: J
authors.lastname: Bushey
authors.forename: Ann M
authors.initials: AM
authors.lastname: Hesketh
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000932:Antiemetics / Q000627:therapeutic use*; D000972:Antineoplastic Agents, Phytogenic / Q000009:adverse effects* / Q000627:therapeutic use; D015179:Colorectal Neoplasms / Q000188:drug therapy; D003907:Dexamethasone / Q000627:therapeutic use; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D015994:Incidence; D002955:Leucovorin / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D009325:Nausea / Q000139:chemically induced / Q000453:epidemiology* / Q000517:prevention & control; D009944:Organoplatinum Compounds / Q000008:administration & dosage; D000077150:Oxaliplatin; D011446:Prospective Studies; D058831:Serotonin 5-HT3 Receptor Antagonists / Q000627:therapeutic use; D013997:Time Factors; D014839:Vomiting / Q000139:chemically induced / Q000453:epidemiology* / Q000517:prevention & control
chemical_list: D000932:Antiemetics; D000972:Antineoplastic Agents, Phytogenic; D009944:Organoplatinum Compounds; D058831:Serotonin 5-HT3 Receptor Antagonists; D000077150:Oxaliplatin; D003907:Dexamethasone; D002955:Leucovorin; D005472:Fluorouracil