Management of platinum-based chemotherapy-induced acute nausea and vomiting: Is there a superior serotonin receptor antagonist?

Mehdi Hamadani, Lubna Chaudhary, Farrukh T. Awan, Jawad K. Khan, Kiarash Kojouri, Howard Ozer, Arafat Tfayli

Research output: Contribution to journalArticle

21 Citations (Scopus)

Abstract

Objective. The last decade has witnessed the great impact of 5-hydroxytryptamine-3 receptor (5-HT3) antagonists in revolutionizing the management of platinum-based chemotherapy-induced acute nausea and vomiting (CINV). However, despite the availability of a variety of 5-HT3 antagonists, little data is published to support superiority of one drug over another, leaving the choice of serotonin receptor antagonist largely empirical. The National Comprehensive Cancer Network and American Society of Clinical Oncology guidelines for management - of chemotherapy-associated nausea and vomiting clearly endorse the use of serotonin receptor antagonist; however, no single agent is preferred over the rest. Methods. Data for patients (n = 159) receiving platinum-based chemotherapy regimens were retrospectively collected. Patients getting 5-HT3 antagonists without steroids or those with known history of brain metastasis, gastroparesis, and intestinal obstruction were not eligible for the study. Patient characteristics including age, gender, primary diagnosis, history of heavy alcohol intake, chemotherapy regimen administered, number of cycles, and Eastern Cooperative Oncology Group performance status at the start of therapy were noted. Primary outcome was the complete control of platinum-induced acute nausea and vomiting. Secondary outcome measures included control of ≥grade 1 nausea or vomiting, comparison of two doses of dexamethasone, and antiemetic efficacy among various platinum drugs. National Cancer Institute Common Toxicity Criteria version 2.0 was used to assess toxicity. Results. A total of 126 patients received 369 cycles of platinum-based therapy. Dolasetron (n=157), granisetron (n=81), and ondansetron (n = 131) achieved complete control of vomiting in 89.8, 95.5, and 92.3% (p=0.67) of cycles, respectively. Respectively, complete nausea control was observed in 68.1, 75.3 and, 69.4% (p=0.50). Dexamethasone 20 mg was not superior to 10 mg in complete control of nausea and vomiting (p=0.15 and p=0.63, respectively). However, complete nausea control was significantly better in the subgroup of patients getting cisplatin-compared with carboplatin-based regimens (78.8% vs. 67.7%, p<0.05). Conclusion. No significant difference exists in the antiemetic efficacy of the three 5-HT3 antagonists studied in controlling CINV when administered in combination with dexamethasone. Choice of antiemetic_regimen should therefore be based on drug cost.

Original languageEnglish (US)
Pages (from-to)69-75
Number of pages7
JournalJournal of Oncology Pharmacy Practice
Volume13
Issue number2
DOIs
StatePublished - Sep 19 2007
Externally publishedYes

Fingerprint

Serotonin Antagonists
Platinum
Nausea
Vomiting
Receptors, Serotonin, 5-HT3
Drug Therapy
Antiemetics
Dexamethasone
Granisetron
Gastroparesis
Ondansetron
Drug Costs
National Cancer Institute (U.S.)
Intestinal Obstruction
Carboplatin
Pharmaceutical Preparations
Cisplatin
Steroids
Alcohols
Outcome Assessment (Health Care)

Keywords

  • Acute emesis
  • Chemotheraphy-induced acute nausea and vomiting
  • Dolasetron
  • Granisetron
  • Ondansetron

ASJC Scopus subject areas

  • Oncology
  • Pharmacology (medical)

Cite this

Management of platinum-based chemotherapy-induced acute nausea and vomiting : Is there a superior serotonin receptor antagonist? / Hamadani, Mehdi; Chaudhary, Lubna; Awan, Farrukh T.; Khan, Jawad K.; Kojouri, Kiarash; Ozer, Howard; Tfayli, Arafat.

In: Journal of Oncology Pharmacy Practice, Vol. 13, No. 2, 19.09.2007, p. 69-75.

Research output: Contribution to journalArticle

Hamadani, Mehdi ; Chaudhary, Lubna ; Awan, Farrukh T. ; Khan, Jawad K. ; Kojouri, Kiarash ; Ozer, Howard ; Tfayli, Arafat. / Management of platinum-based chemotherapy-induced acute nausea and vomiting : Is there a superior serotonin receptor antagonist?. In: Journal of Oncology Pharmacy Practice. 2007 ; Vol. 13, No. 2. pp. 69-75.
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abstract = "Objective. The last decade has witnessed the great impact of 5-hydroxytryptamine-3 receptor (5-HT3) antagonists in revolutionizing the management of platinum-based chemotherapy-induced acute nausea and vomiting (CINV). However, despite the availability of a variety of 5-HT3 antagonists, little data is published to support superiority of one drug over another, leaving the choice of serotonin receptor antagonist largely empirical. The National Comprehensive Cancer Network and American Society of Clinical Oncology guidelines for management - of chemotherapy-associated nausea and vomiting clearly endorse the use of serotonin receptor antagonist; however, no single agent is preferred over the rest. Methods. Data for patients (n = 159) receiving platinum-based chemotherapy regimens were retrospectively collected. Patients getting 5-HT3 antagonists without steroids or those with known history of brain metastasis, gastroparesis, and intestinal obstruction were not eligible for the study. Patient characteristics including age, gender, primary diagnosis, history of heavy alcohol intake, chemotherapy regimen administered, number of cycles, and Eastern Cooperative Oncology Group performance status at the start of therapy were noted. Primary outcome was the complete control of platinum-induced acute nausea and vomiting. Secondary outcome measures included control of ≥grade 1 nausea or vomiting, comparison of two doses of dexamethasone, and antiemetic efficacy among various platinum drugs. National Cancer Institute Common Toxicity Criteria version 2.0 was used to assess toxicity. Results. A total of 126 patients received 369 cycles of platinum-based therapy. Dolasetron (n=157), granisetron (n=81), and ondansetron (n = 131) achieved complete control of vomiting in 89.8, 95.5, and 92.3{\%} (p=0.67) of cycles, respectively. Respectively, complete nausea control was observed in 68.1, 75.3 and, 69.4{\%} (p=0.50). Dexamethasone 20 mg was not superior to 10 mg in complete control of nausea and vomiting (p=0.15 and p=0.63, respectively). However, complete nausea control was significantly better in the subgroup of patients getting cisplatin-compared with carboplatin-based regimens (78.8{\%} vs. 67.7{\%}, p<0.05). Conclusion. No significant difference exists in the antiemetic efficacy of the three 5-HT3 antagonists studied in controlling CINV when administered in combination with dexamethasone. Choice of antiemetic_regimen should therefore be based on drug cost.",
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AU - Chaudhary, Lubna

AU - Awan, Farrukh T.

AU - Khan, Jawad K.

AU - Kojouri, Kiarash

AU - Ozer, Howard

AU - Tfayli, Arafat

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N2 - Objective. The last decade has witnessed the great impact of 5-hydroxytryptamine-3 receptor (5-HT3) antagonists in revolutionizing the management of platinum-based chemotherapy-induced acute nausea and vomiting (CINV). However, despite the availability of a variety of 5-HT3 antagonists, little data is published to support superiority of one drug over another, leaving the choice of serotonin receptor antagonist largely empirical. The National Comprehensive Cancer Network and American Society of Clinical Oncology guidelines for management - of chemotherapy-associated nausea and vomiting clearly endorse the use of serotonin receptor antagonist; however, no single agent is preferred over the rest. Methods. Data for patients (n = 159) receiving platinum-based chemotherapy regimens were retrospectively collected. Patients getting 5-HT3 antagonists without steroids or those with known history of brain metastasis, gastroparesis, and intestinal obstruction were not eligible for the study. Patient characteristics including age, gender, primary diagnosis, history of heavy alcohol intake, chemotherapy regimen administered, number of cycles, and Eastern Cooperative Oncology Group performance status at the start of therapy were noted. Primary outcome was the complete control of platinum-induced acute nausea and vomiting. Secondary outcome measures included control of ≥grade 1 nausea or vomiting, comparison of two doses of dexamethasone, and antiemetic efficacy among various platinum drugs. National Cancer Institute Common Toxicity Criteria version 2.0 was used to assess toxicity. Results. A total of 126 patients received 369 cycles of platinum-based therapy. Dolasetron (n=157), granisetron (n=81), and ondansetron (n = 131) achieved complete control of vomiting in 89.8, 95.5, and 92.3% (p=0.67) of cycles, respectively. Respectively, complete nausea control was observed in 68.1, 75.3 and, 69.4% (p=0.50). Dexamethasone 20 mg was not superior to 10 mg in complete control of nausea and vomiting (p=0.15 and p=0.63, respectively). However, complete nausea control was significantly better in the subgroup of patients getting cisplatin-compared with carboplatin-based regimens (78.8% vs. 67.7%, p<0.05). Conclusion. No significant difference exists in the antiemetic efficacy of the three 5-HT3 antagonists studied in controlling CINV when administered in combination with dexamethasone. Choice of antiemetic_regimen should therefore be based on drug cost.

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