title: Incidence of delayed nausea and vomiting in patients  with colorectal cancer receiving irinotecan-based  chemotherapy.
abstract: OBJECTIVE
  This study sought to prospectively determine the frequency of delayed nausea and vomiting with irinotecan-based chemotherapy following day 1 prophylaxis with a 5-HT3 receptor antagonist and dexamethasone.
  
  
  METHODS
  Patients with colorectal cancer aged ≥ 18 years with ECOG performance status ≤ 2 receiving irinotecan alone, combined with cetuximab or as part of a standard folinic acid, 5- fluorouracil, irinotecan (FOLFIRI) regimen for the first time were eligible. All patients received a 5-HT3 receptor antagonist and dexamethasone 8 mg on day 1 prior to irinotecan. No routine prophylaxis for delayed emesis was given. Antiemetic outcome was recorded in patient-completed diaries for the 120-h study period after irinotecan administration. Primary endpoint was frequency of delayed (24-120 h) emesis.
  
  
  RESULTS
  Forty-four patients were enrolled, and all are evaluable. The median age was 61 (39-79) years; the male-female ratio was 37:7. Four patients (9%) experienced vomiting or retching during the delayed period. Three patients (7%) vomited during the first 24 h after irinotecan. The overall no emesis rate was 89% (39/44). Fifteen patients (34%) experienced delayed nausea (mildin 11 patients, moderate in four patients). Six patients (14%) took rescue antiemetics during the delayed period. Delayed and overall complete response (no emesis or use of rescue antiemetics) rates were 82% and 77% respectively.
  
  
  CONCLUSIONS
  The use of a 5-HT3 antagonist and dexamethasone prior to irinotecan results in excellent control of nausea and vomiting (CR 86%) during the 24 h after chemotherapy. Without further antiemetic treatment, most patients (82%) will not experience delayed emesis or require rescue antiemetics. Routine prophylaxis for delayed emesis following irinotecan does not appear to be warranted.
authors: Lahey Clinic Medical Center, Burlington, MA, USA. Paul.Hesketh@lahey.org
authors: Paul J
authors: PJ
authors: Hesketh
authors: Snezana M
authors: SM
authors: Bosnjak
authors: Vlada
authors: V
authors: Nikolic
authors: Bernardo
authors: B
authors: Rapoport
mesh_terms: D000328:Adult; D000368:Aged; D000932:Antiemetics / Q000378:metabolism / Q000627:therapeutic use; D000972:Antineoplastic Agents, Phytogenic / Q000009:adverse effects* / Q000627:therapeutic use; D002166:Camptothecin / Q000009:adverse effects / Q000031:analogs & derivatives*; D015179:Colorectal Neoplasms / Q000188:drug therapy*; D003907:Dexamethasone / Q000378:metabolism / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D015994:Incidence; D000077146:Irinotecan; D008297:Male; D008875:Middle Aged; D009325:Nausea / Q000139:chemically induced / Q000517:prevention & control*; D011446:Prospective Studies; D058831:Serotonin 5-HT3 Receptor Antagonists / Q000378:metabolism / Q000627:therapeutic use; D014839:Vomiting / Q000139:chemically induced / Q000517:prevention & control*
chemical_list: D000932:Antiemetics; D000972:Antineoplastic Agents, Phytogenic; D058831:Serotonin 5-HT3 Receptor Antagonists; D000077146:Irinotecan; D003907:Dexamethasone; D002166:Camptothecin