title: Efficacy of granisetron and aprepitant in a patient who failed ondansetron in the prophylaxis of radiation induced nausea and vomiting: a case report.
abstract: BACKGROUND
  Radiotherapy-induced nausea and vomiting (RINV) is a toxicity that can occur in 40-80% of individuals who receive radiation treatment. Current guidelines recommend 5-hydroxytryptamine3 receptor antagonists (5-HT3 RAs) for prophylaxis of RINV for moderate and highly emetogenic radiotherapy; however, certain patients may suffer from RINV despite prophylaxis.
  
  
  METHODS
  This report details the case of a 47-year-old female with extensive bony involvement to the spine from breast cancer presenting with lower back pain.
  
  
  RESULTS
  To palliate her symptoms, the patient underwent a course of irradiation to the lumbar spine and was prescribed ondansetron as an antiemetic. However, the patient experienced severe nausea and emesis and was subsequently switched to granisetron and aprepitant.
  
  
  METHODS
  The patient completed the remainder of the radiation treatment with no further emesis and minimal nausea, representing the first documented success of granisetron and aprepitant for RINV after failure on ondansetron.
  
  
  CONCLUSIONS
  In chemotherapy, switching 5-HT3 RAs after failure on the first is successful in preventing chemotherapy-induced nausea and vomiting (CINV), yet this has not been previously reported in radiation. In this patient, granisetron and aprepitant were successful in substantially reducing nausea and preventing further emesis, and may represent an alternative antiemetic regimen for RINV prophylaxis and salvage.
authors: Rapid Response Radiotherapy Program, Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada.
authors: Leigha
authors: L
authors: Rowbottom
authors: Rapid Response Radiotherapy Program, Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada.
authors: Mark
authors: M
authors: Pasetka
authors: Rapid Response Radiotherapy Program, Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada.
authors: Rachel
authors: R
authors: McDonald
authors: Rapid Response Radiotherapy Program, Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada.
authors: Lise
authors: L
authors: Hunyh
authors: Rapid Response Radiotherapy Program, Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada.
authors: Srinivas
authors: S
authors: Raman
authors: Rapid Response Radiotherapy Program, Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada.
authors: Carlo
authors: C
authors: DeAngelis
authors: Rapid Response Radiotherapy Program, Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada. Edward.Chow@sunnybrook.ca.
authors: Edward
authors: E
authors: Chow
mesh_terms: D000932:Antiemetics / Q000008:administration & dosage*; D000077608:Aprepitant; D001859:Bone Neoplasms / Q000532:radiotherapy* / Q000556:secondary; D001943:Breast Neoplasms / Q000473:pathology*; D005260:Female; D017829:Granisetron / Q000008:administration & dosage; D006801:Humans; D008875:Middle Aged; D009025:Morpholines / Q000008:administration & dosage; D009325:Nausea / Q000209:etiology / Q000517:prevention & control*; D009362:Neoplasm Metastasis; D017294:Ondansetron / Q000008:administration & dosage
chemical_list: D000932:Antiemetics; D000077608:Aprepitant; D017829:Granisetron; D009025:Morpholines; D017294:Ondansetron
keywords: Radiotherapy; aprepitant; granisetron; ondansetron; serotonin 5-hydroxytryptamine3 receptor antagonists (5-HT3 RAs)