Poor chemotherapy-induced nausea and vomiting control in children receiving intermediate or high dose methotrexate.
OBJECTIVE
Chemotherapy emetogenicity is the most important known determinant of chemotherapy-induced vomiting (CIV) in children. However, direct evidence regarding the emetogenic potential of chemotherapeutic agents in children is limited. This study describes the prevalence of complete control of acute and delayed phase chemotherapy-induced nausea and vomiting (CINV) in children receiving methotrexate. The prevalence of anticipatory CINV is described, and risk factors for CINV are explored.


METHODS
English-speaking children (4 to 18 years) receiving intermediate-dose (ID-MTX: >1 to <12 g/m(2)/dose) or high-dose methotrexate (HD-MTX: ≥12 g/m(2)/dose) participated in this prospective study. Emetic episodes, nausea severity, and antiemetic administration were documented for 24 h from the start of the methotrexate infusion (acute phase) and for up to a further 168 h (delayed phase). CINV prophylaxis was provided at the discretion of the treating physician. Anticipatory CINV was assessed in the 24 h preceding chemotherapy. Complete CINV control was defined as no emetic episodes and no nausea.


RESULTS
Thirty children (mean age, 11.8 ± 4 years; ID-MTX, 20; HD-MTX, 10) completed the study. CINV prophylaxis included the following: ondansetron/granisetron plus dexamethasone or nabilone. Few patients experienced complete CINV control (ID-MTX: acute phase 20%, delayed phase 5%; HD-MTX: acute phase 0%, delayed phase 30%). Complete emesis control was higher (ID-MTX: acute phase 70%, delayed phase 50%; HD-MTX: acute phase 70%, delayed phase 60%). Anticipatory CINV was reported by 6/28 patients (21%). Patient age, sex, and history of motion sickness were not significant predictors of CINV.


CONCLUSIONS
The poor complete CINV control rate in children receiving methotrexate confirms the classification of HD-MTX as highly emetogenic chemotherapy (HEC) and suggests that ID-MTX be reclassified as HEC.
Department of Pharmacy, The Hospital for Sick Children, Toronto, Canada.
Helen
H
Vol
Department of Pharmacy, The Hospital for Sick Children, Toronto, Canada.|Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada.
Jacqueline
J
Flank
Rideau Community Health Services, Smith Falls, Canada.
Sara R
SR
Lavoratore
Department of Paediatrics, Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Canada.|Research Institute, The Hospital for Sick Children, Toronto, Canada.
Paul C
PC
Nathan
Department of Pharmacy, The Hospital for Sick Children, Toronto, Canada.
Tracey
T
Taylor
Department of Pharmacy, The Hospital for Sick Children, Toronto, Canada.
Elyse
E
Zelunka
Department of Nursing, The Hospital for Sick Children, Toronto, Canada.
Anne Marie
AM
Maloney
Department of Pharmacy, The Hospital for Sick Children, Toronto, Canada. lee.dupuis@sickkids.ca.|Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada. lee.dupuis@sickkids.ca.|Research Institute, The Hospital for Sick Children, Toronto, Canada. lee.dupuis@sickkids.ca.|Peter Gilgan Centre for Research and Learning, 686 Bay Street, Toronto, ON, M5G 0A4, Canada. lee.dupuis@sickkids.ca.
L
L
Lee Dupuis
D000293:Adolescent; D000932:Antiemetics / Q000627:therapeutic use*; D000964:Antimetabolites, Antineoplastic / Q000009:adverse effects*; D000970:Antineoplastic Agents / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D008727:Methotrexate / Q000009:adverse effects*; D009325:Nausea / Q000139:chemically induced*; D011446:Prospective Studies; D012307:Risk Factors; D014839:Vomiting / Q000139:chemically induced*
D000932:Antiemetics; D000964:Antimetabolites, Antineoplastic; D000970:Antineoplastic Agents; D008727:Methotrexate
Chemotherapy; Children; Emetogenicity; Methotrexate; Nausea; Vomiting