Skip to main content
SpringerLink
Log in

Comparative studies of various antiemetic regimens

  • Special Article
  • Published:
Supportive Care in Cancer Aims and scope Submit manuscript

Abstract

Since 1981, when highdose intravenous metoclopramide was demonstrated to be efficacious, slow but constant improvement in the prevention of chemotherapy-induced emesis has been achieved. Today, a combination of a serotonin receptor 3 (5-HT3) antagonist plus dexamethasone can be considered the most efficacious treatment for the prevention of emesis induced by cisplatin and by moderately emetogenic chemotherapy. Which 5-HT3receptor antagonist should be used? Preclinical differences among 5-HT3receptor antagonists have been reported with regard to selectivity of receptor binding, potency, dose response, and duration of action. Twelve comparative studies among 5-HT3receptor antagonists have been carried out. Unfortunately, all these trials have some important shortcomings (patient population not large enough to show small but clinically important differences; not blinded studies; no association with steroids to maximize treatment efficacy) and, therefore, no definitive conclusions can be drawn. Very recently three large, well-conducted double-blind comparative studies have been published. All three showed that 5-HT3receptor antagonists have almost identical antiemetic efficacy and tolerability. Therefore, the choice among the 5-HT3receptor antagonists should be based only on the acquisition cost of the prescribed dose in each country for each compound.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Andrews PL, Bhandari P, Davey PT, et al (1992) Are all 5-HT3 receptor antagonists the same? Eur J Cancer 28A [Suppl 1]:2–6

    Google Scholar 

  2. Basurto C, Roila F, Bracarda S, et al (1988) A double-blind trial comparing antiemetic efficacy and toxicity of metoclopramide vs methylprednisolone vs domperidone in patients receiving doxorubicin chemotherapy alone or in combination with other antiblastic agents. Am J Clin Oncol 11:594–596

    PubMed  Google Scholar 

  3. Beck TM, Hesketh PJ, Madajewicz S, et al (1992) Stratified, randomized, double-blind comparison of intravenous ondansetron administered as a multiple-dose regimen versus two single-dose regimens in the prevention of cisplatin-induced nausea and vomiting. J Clin Oncol 10:1969–1975

    PubMed  Google Scholar 

  4. Beck TM, Ciociola AA, Jones SE, et al (1993) Efficacy of oral ondansetron in the prevention of emesis in outpatients receiving cyclophosphamidebased chemotherapy. Ann Intern Med 118:407–413

    PubMed  Google Scholar 

  5. Bonneterre J, Chevallier B, Metz R, et al (1990) A randomized doubleblind comparison of ondansetron and metoclopramide in the prophylaxis of emesis induced by cyclophosphamide, fluorouracil and doxorubicin or epirubicin chemotherapy. J Clin Oncol 8:1063–1069

    PubMed  Google Scholar 

  6. Bonneterre J, Hecquet B, on behalf of the French Northern Oncology Group (1993) Granisetron i.v. compared with ondansetron i.v. plus tablets in the prevention of nausea and vomiting induced by a moderately emetogenic chemotherapy regimen: a randomized cross-over study. In: Satellite Symposium to the 7th European Conference of Clinical Oncology and Cancer Nursing, Jerusalem, Israel, November 1993 (abstract book). Adelphi Communication, Macclesfield, UK, pp 22–24

    Google Scholar 

  7. Campora E, Simoni C, Rosso R (1994) Tropisetron versus ondansetron nella prevenzione e controllo dell'emesi in pazienti sottoposte a chemioterapia con FAC/FEC per carcinoma mammario metastatico o operato. Minerva Med 85:25–31

    PubMed  Google Scholar 

  8. Chiara S, Campora E, Lionetto R, et al (1987) Methylprednisolone for the control of CMF-induced emesis. Am J Clin Oncol 10:264–267

    PubMed  Google Scholar 

  9. Del Favero A, Roila F, Tonato M (1993) Reducing chemotherapy-induced nausea and vomiting. Current perspectives and future possibilities. Drug Safety 9:410–428

    PubMed  Google Scholar 

  10. Dicato M (1991) Oral treatment with ondansetron in an outpatient setting. Eur J Cancer 27 [Suppl 1]:518–519

    PubMed  Google Scholar 

  11. Fraschini G, Ciociola A, Esparza L, et al (1991) Evaluation of three oral dosages of ondansetron in the prevention of nausea and emesis associated with cyclophosphamide-doxorubicin chemotherapy. J Clin Oncol 9:1268–1274

    PubMed  Google Scholar 

  12. Gebbia V, Cannata G, Testa A, et al (1994) Ondansetron versus granisetron in the prevention of chemotherapy-induced nausea and vomiting. Cancer 74:1945–1952

    PubMed  Google Scholar 

  13. Gralla RJ, Itri LM, Pisko SE, et al (1981) Antiemetic efficacy of highdose metoclopramide: randomized trials with placebo and prochlorperazine in patients with chemotherapyinduced nausea and vomiting. N Engl J Med 305:905–909

    PubMed  Google Scholar 

  14. Hacking A, on behalf of the Granisetron Study Group (1992) Oral granisetron-simple and effective: a preliminary report. Eur J Cancer 28A [Suppl 1]: S28-S32

    PubMed  Google Scholar 

  15. Heron JF, Goedhals L, Jordan JP, et al (1994) Oral granisetron alone and in combination with dexamethasone: a double-blind randomized comparison against high-dose metoclopramide plus dexamethasone in prevention of cisplatin-induced emesis. Ann Oncol 5:579–584

    PubMed  Google Scholar 

  16. Hesketh PJ, Harvey WH, Harker WG, et al (1994) A randomized, double-blind comparison of intravenous ondansetron alone and in combination with intravenous dexamethasone in the prevention of high-dose cisplatin-induced emesis. J Clin Oncol 12:596–600

    PubMed  Google Scholar 

  17. Hulstaert F, Van Belle S, Bleiberg H, et al (1994) Optimal combination therapy with tropisetron in 445 patients with incomplete control of chemotherapy-induced nausea and vomiting. J Clin Oncol 12:2439–2446

    PubMed  Google Scholar 

  18. Italian Group for Antiemetic Research (1992) Ondansetron + dexamethasone versus metoclopramide + dexamethasone + diphenhydramine in prevention of cisplatin-induced emesis. Lancet 340:96–99

    Google Scholar 

  19. Italian Group for Antiemetic Research (1993) Difference in persistence of efficacy of two antiemetic re gimens on acute emesis during cisplatin chemotherapy. J Clin Oncol 11:2396–2404

    Google Scholar 

  20. Jantunen IT, Kataja VV, Johansson RT (1992) Ondansetron and tropisetron with dexamethasone in the prophylaxis of acute vomiting induced by non-cisplatin-containing chemotherapy. Acta Oncol 31:573–575

    PubMed  Google Scholar 

  21. Jantunen IT, Muhonen TT, Kataja VV, et at (1993) 5-HT3 receptor antagonists in the prophylaxis of acute vomiting induced by moderately emetogenic chemotherapy - a randomised study. Eur J Cancer 29A:1669–1672

    PubMed  Google Scholar 

  22. Johnsonbaugh RE, Mason BA, Friedman CJ, et al (1994) Oral granisetron is an effective anti-emetic in patients receiving moderately emetogenic chemotherapy. Proc Am Soc Clin Oncol Annu Meet 13:437

    Google Scholar 

  23. Jones AL, Hill AS, Soukop M, et al (1991) Comparison of dexamethasone in the prophylaxis of emesis induced by moderately emetogenic chemotherapy. Lancet 338:483–487

    PubMed  Google Scholar 

  24. Joss RA, Bacchi M, Buser K, et al (1994) Ondansetron plus dexamethasone is superior to ondansetron alone in the prevention of emesis in chemotherapy-naive and previously treated patients. Ann Oncol 5:253–258

    PubMed  Google Scholar 

  25. Kaasa S, Kvaloy S, Dicato MA, et al (1990) A comparison of ondansetron with metoclopramide in the prophylaxis of chemotherapy-induced nausea and vomiting: a randomized, doubleblind study. Eur J Cancer 26:311–314

    PubMed  Google Scholar 

  26. Kaizer L, Warr D, Hoskins P, et al (1994) Effect of schedule and maintenance on the antiemetic efficacy of ondansetron combined with dexamethasone in acute and delayed nausea and emesis in patients receiving moderately emetogenic chemotherapy: a phase III trial by the National Cancer Institute of Canada Clinical Trials Group. J Clin Oncol 12:1050–1057

    PubMed  Google Scholar 

  27. Latreille J, Stewart D, Laberge F, et al (1993) Dexamethasone (DEX) improves the efficacy of granisetron (GRAN) in the first 24 hours following high dose cisplatin (HDCP) chemotherapy. Eur J Cancer 29A [Suppl 6]:S 208

    PubMed  Google Scholar 

  28. Mantovani G, Maccio A, Curreli L, et al (1994) Comparison of the effectiveness of three 5-HT3 receptor an tagonists in the prophylaxis of acute vomiting induced by highly emetogenic chemotherapy (high-dose cisplatin) for treatment of primary head and neck cancer. Proc Am Sue Clin Oncol Annu Meet 13:428

    Google Scholar 

  29. Markman M, Sheidler V, Ettinger DS, et al (1984) Antiemetic efficacy of dexamethasone. Randomized, double-blind, crossover study with prochlorperazine in patients receiving cancer chemotherapy. N Engl J Med 311:549–552

    PubMed  Google Scholar 

  30. Marschner NW, Adler M, Nagel GA, et al (1991) Double-blind randomised trial of the antiemetic efficacy and safety of ondansetron and metoclo pramide in advanced breast cancer patients treated with epirubicin and cyclophosphamide. Fur J Cancer 27:1137–1140

    Google Scholar 

  31. Martoni A, Angelelli B, Guaraldi E, et al (1994) Granisetron versus ondansetron in the prevention of cispla tin-induced emesis. An open randomised cross-over study. Proc Am Soc Clin Oncol Annu Meet 13:431

    Google Scholar 

  32. Marty M, d'Allens H, Groupe Multicentrique Français (1990) Etude randomis6e en double-insu comparant l'efficacité de l'ondansetron selon deux modes d'administration: injection unique et perfusion continue. Cah Cancer 2:541–546

    Google Scholar 

  33. Marty M, Granisetron Study Group (1990) A comparative study of the use of granisetron, a selective 5-HT3 antagonist, versus a standard antiemetic regimen of chlorpromazine plus dexamethasone in the treatment of cytostatic-induced emesis. Eur J Cancer 26 [Suppl 1]:28–32

    Google Scholar 

  34. Marty M, Kleisbauer J-P, Fournel P, et al (1995) Is Navoban (tropisetron) as effective as Zofran (ondansetron) in cisplatin-induced emesis? Anti Cancer Drugs 6:15–21

    Google Scholar 

  35. Massidda B, Laconi S, Foddi MR, et al (1994) Prevention of non-cisplatin induced emesis: role of the antagon ists of 5-HT3 receptors. Ann Oncol 5 [Suppl 8]:204

    Google Scholar 

  36. Navari RM, Kaplan HG, Gralla RJ, et al (1994) Efficacy and safety of granisetron, a selective 5-hydroxytryptamine-3 receptor antagonist, in the prevention of nausea and vomiting induced by high-dose cisplatin. J Clin Oncol 12:2204–2210

    PubMed  Google Scholar 

  37. Navari R, Hesketh P, Grote T, et al (1995) A double-blind, randomized, comparative i.v. study of single dose dolasetron vs ondansetron in preventing cisplatin-related emesis. Proc Am Soc Clin Oncol Annu Meet 14:522

    Google Scholar 

  38. avari R, Hesketh P, Hall S, et al, on behalf of the Granisetron Study Group (1995) Comparative clinical trial of granisetron and ondansetron in the prophylaxis of cisplatin-induced emesis. J Clin Oncol 13:1242–1248

    PubMed  Google Scholar 

  39. Noble A, Bremer K, Goedhals L, et al (1994) A double-blind, randomised, crossover comparison of granisetron and ondansetron in 5-day fractionated chemotherapy: assessment of efficacy, safety and patient preference. Fur J Cancer 30A:1083–1088

    Google Scholar 

  40. Perez EA (1994) Acute emesis: can oral treatment match i.v.? Extended abstracts of the Satellite Symposium “Emesis control and beyond”, 19th ESMO Congress, Lisbon, 1994, pp 18–25

  41. Pollera CF, Nardi M, Marolla P, et al (1989) Effective control of CMF-related emesis with high-dose dexamethasone: results of a double-blind, crossover trial with metoclopramide and placebo. Am J Clin Oncol 12:524–529

    PubMed  Google Scholar 

  42. Riviere A, on behalf of the Granisetron Study Group (1994) Dose finding study of granisetron in patients receiving high-dose cisplatin chemotherapy. Br J Cancer 69:967–971

    PubMed  Google Scholar 

  43. Roila F, Basurto C, Minotti V, et al (1988) Methylprednisolone vs metoclopramide for prevention of nausea and vomiting in breast cancer patients treated with intravenous cyclophosphamide, methotrexate, 5-fluorouracil: a double-blind randomized study. Oncology 45:346–349

    PubMed  Google Scholar 

  44. Roila F, Tonato M, Basurto C, et al (1989) Protection from nausea and vomiting in cisplatin-treated patients: high-dose metoclopramide combined with methylprednisolone versus metoclopramide combined with dexamethasone and diphenhydramine: a study of the Italian Oncology Group for Clinical Research. J Clin Oncol 7:1693–1700

    PubMed  Google Scholar 

  45. Roila F, Tonato M, Cognetti F, et al (1991) Prevention of cisplatin-induced emesis: a double-blind multicentrr randomized crossover study comparing ondansetron and ondansetron plus dexamethasone. J Clin Oncol 9:675–678

    PubMed  Google Scholar 

  46. Roila F, De Angelis V, Cognetti F, et al (1995) Ondansetron vs granisetron, both combined with dexamethasone in the prevention of cisplatin-induced emesis. Proc Am Soc Clin Oncol Annu Meet 14:523

    Google Scholar 

  47. Ruff P, Paska W, Goedhals L, et al, on behalf of the Ondansetron and Granisetron Emesis Study Group (1994) Ondansetron compared with granisetron in the prophylaxis of cisplatin-induced acute emesis: a multicentre double-blind, randomised, parallel group study. Oncology 51:113–118

    PubMed  Google Scholar 

  48. Schmidt M, Sorbe B, Hogberg T, et al (1993) Efficacy and tolerability of tropisetron and dexamethasone in the control of nausea and vomiting induced by cisplatin. Ann Oncol 4 [Suppl 3]:31–34

    Google Scholar 

  49. Seynaeve C, Schuller J, Buser K, et al (1992) Comparison of the antiemetic efficacy of different doses of ondansetron given as either a continuous infusion or a single intravenous dose, in acute cisplatin-induced emesis. A multicentre, double-blind, randomised, parallel group study. Br J Cancer 66:192–197

    PubMed  Google Scholar 

  50. Smith DB, Newlands ES, Rustin GJS, et al (1991) Comparison of ondansetron and ondansetron plus dexamethasone as antiemetic prophylaxis during cisplatin-containing chemotherapy. Lancet 338:487–490

    PubMed  Google Scholar 

  51. Smyth JF, Coleman RE, Nicolson M, et al (1991) Does dexamethasone enhance control of acute cisplatin in duced emesis by ondansetron? Br Med J 303:1423–1426

    Google Scholar 

  52. Soukop M, on behalf of the Granisetron Study Group (1994) A dosefinding study of granisetron, a novel antiemetic, in patients receiving highdose cisplatin. Support Care Cancer 2:177–183

    PubMed  Google Scholar 

  53. Stewart A, McQuade B, Cronje JDE, et al (1995) Ondansetron compared with granisetron in the prophylaxis of cyclophosphamide-induced emesis in out-patients: a multicentre, doubleblind, double-dummy, randomised, parallel-group study. Oncology 52:202–210

    PubMed  Google Scholar 

  54. The Italian Group for Antiemetic Research (1995) Dexamethasone, granisetron, or both for the prevention of nausea and vomiting during chemotherapy for cancer. N Engl J Med 332:1–5

    Google Scholar 

  55. The Italian Group for Antiemetic Research (1995) Persistence of efficacy of three antiemetic regimens and prognostic factors in patients undergoing moderately emetogenic chemotherapy. J Clin Oncol 13:2417–2426

    Google Scholar 

  56. Van Belle SJP, Stamatakis L, Bleiberg H, et al (1994) Dose-finding study of tropisetron in cisplatin-in duced nausea and vomiting. Ann Oncol 5:821–825

    PubMed  Google Scholar 

  57. Warr D, Willan A, Fine S, et al (1991) Superiority of granisetron to dexamethasone plus prochlorperazine in the prevention of chemotherapy-induced emesis. J Natl Cancer Inst 83:1169–1173

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Medical Oncology Division, Policlinico Hospital, 1-06122, Perugia, Italy

    Fausto oila M.D. & Maurizio Tonato M.D.

  2. Medical Statistics Unit, Department of Internal Medicine and Public Health, University of L'Aquila, L'Aquila, Italy

    Enzo Ballatori Ph.D.

  3. Department of Internal Medicine and Oncological Sciences, University of Perugia, Perugia, Italy

    Albano Del Favero M.D.

Authors
  1. Fausto oila M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Maurizio Tonato M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Enzo Ballatori Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Albano Del Favero M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Additional information

Presented in part as an invited lecture at the 7th International Symposium: Supportive Care in Cancer, Luxembourg, 20-23 September 1995

Rights and permissions

Reprints and permissions

About this article

Cite this article

oila, F., Tonato, M., Ballatori, E. et al. Comparative studies of various antiemetic regimens. Support Care Cancer 4, 270–280 (1996). https://doi.org/10.1007/BF01358879

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF01358879

Key words

Search

Navigation