Skip to main content
SpringerLink
Log in

Stratified Administration of Serotonin 5-HT3 Receptor Antagonists (Setrons) for Chemotherapy-Induced Emesis

Economic Implications

  • Review Article
  • Published:
PharmacoEconomics Aims and scope Submit manuscript

Abstract

The serotonin 5-HT3 receptor antagonists or ‘setrons’ have become the standard of care for the prevention of chemotherapy-induced emesis (CIE) and are first-line therapy for acute CIE in healthcare organisations worldwide. However, their superior efficacy versus standard antiemetics comes at a significant cost. Currently, 3 agents are available in the US: ondansetron, granisetron and dolasetron.

The most important treatment-related factor contributing to CIE is the emetogenicity of chemotherapy. The ability to customise, or stratify, the setron dose to match the emetogenic challenge of the chemotherapy administered has potential benefits, both clinically and economically. In adults, there is an appreciable amount of clinical literature addressing stratified administration; however, the amount of ‘hard’ economic data is rather limited. Intuitively, if clinical outcomes are equivalent, then stratified administration should be associated with economic benefits, as it generally promotes the use of doses lower than those recommended by the manufacturer. The literature strongly substantiates this for ondansetron, but is not as favourable for granisetron or dolasetron.

As the rationale and justification for dose stratification is contained in the clinical literature, the authors have reviewed the pertinent literature supporting the clinical and economic benefits of dose stratification in both adult and paediatric patients. The authors also provide a discussion of various additional strategies that can be employed to ensure the appropriate and cost-effective use of setrons in real-world practice settings. These strategies include the use of lower doses than recommended by manufacturers, use for acute versus delayed phase emesis, enhancing the antiemetic efficacy by the addition of a corticosteroid, use of oral versus injectable formulations (when appropriate) and the implementation and use of local, national and international drug use guidelines.

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

Table I
Table II
Table III
Table IV
Table V
Table VI
Table VII
Table VIII
Table IX
Fig. 1
Fig. 2
Table X
Table XI

Similar content being viewed by others

References

  1. Hesketh PJ, Kris MG, Grunberg SM, et al. Proposal for classifying the acute emetogenicity of cancer chemotherapy. J Clin Oncol 1997; 15: 103–9

    PubMed  CAS  Google Scholar 

  2. Gralla RJ, Kris MG, Tyson LB. Controlling emesis in patients receiving cancer chemotherapy. Cancer Res 1988; 108: 89–101

    CAS  Google Scholar 

  3. Graves T. Ondansetron: a new entity in emesis control. DICP Ann Pharmacother 1990; 24: S51–3

    Google Scholar 

  5. Milne RJ, Heel RC. Ondansetron. Therapeutic use as an antiemetic. Drugs 1991; 41 (4): 574–95

    Article  PubMed  CAS  Google Scholar 

  6. Markham A, Sorkin EM. Ondansetron: an update of its therapeutic use in chemotherapy induced and postoperative nausea and vomiting. Drugs 1993; 45 (6): 931–52

    Article  PubMed  CAS  Google Scholar 

  7. Kris MG, Gralla RJ, Clark RA, et al. Dose-ranging evaluation of the serotonin antagonist GRC507/75 (GR38032F) when used as an antiemetic in patients receiving anticancer chemotherapy. J Clin Oncol 1988; 6: 659–62

    PubMed  CAS  Google Scholar 

  8. Grunberg SM, Stevenson LL, Russell CA, et al. Dose ranging phase I study of the serotonin antagonist GR38032F for prevention of cisplatin-induced nausea and vomiting. J Clin Oncol 1989 7: 1137–41

    PubMed  CAS  Google Scholar 

  9. Roila F, Ballatori E, De Angelis V, et al. Double-blind, dosefinding study of four intravenous doses of dexamethasone in the prevention of cisplatin-induced acute emesis. J ClinOncol 1998; 16: 2937–42

    Google Scholar 

  10. Pectasides D, Mylonakis A, Varthalitis J, et al. Comparison of two different doses of ondansetron plus dexamethasone in the prophylaxis of cisplatin-induced emesis. Oncology 1997; 54 (1): 1–6

    Article  PubMed  CAS  Google Scholar 

  11. Olver I, PaskaW, Depierre A. Amulticenter, double-blind study comparing placebo, ondansetron and ondansetron plus dexamethasone for the control of cisplatin-induced delayed emesis. Ann Oncol 1996; 7 (9): 945–52

    Article  PubMed  CAS  Google Scholar 

  12. Mantovani G, Maccio A, Bianchi A, et al. Cancer 1996; 77 (5): 941–8

    Article  PubMed  CAS  Google Scholar 

  13. Sylvester RK, Etzell R, Levitt R, et al. Comparison of 16mg vs 32mg ondansetron and dexamethasone in patients receiving cisplatin [abstract 1781]. Proc Am Soc Clin Oncol 1996; 15: 547

    Google Scholar 

  14. Basurto C, Ciccarese G, Palladino MA, et al. Ondansetron versus granisetron, both combined with dexamethasone, in the prevention of cisplatin-induced emesis. Ann Oncol 1995; 6 (8): 805–10

    Google Scholar 

  15. Tyson L, Kris MG, Baltzer L, et al. Randomized phase II trial comparing two versus three doses of ondansetron when used with dexamethasone in patients receiving cisplatin > 100 mg/m2. Am J Clin Oncol 1994; 17: 269–72

    Article  PubMed  CAS  Google Scholar 

  16. Gebbia V, Cannata G, Testa A, et al. Ondansetron versus granisetron in the prevention of chemotherapy-induced nausea and vomiting. Cancer 1994; 74 (7): 1945–52

    Article  PubMed  CAS  Google Scholar 

  17. Ruff P, Paska W, Pouillart P, et al. Ondansetron compared with granisetron in the prophylaxis of cisplatin-induced acute emesis: a multicentre double-blind, randomised, parallel-group study. Oncology 1994; 51: 113–8

    Article  PubMed  CAS  Google Scholar 

  18. Seynaeve C, Schuller J, Buser K, et al. Comparison of the antiemetic efficacy of different doses of ondansetron, given as either a continuous infusion of a single intravenous dose, in acute cisplatin-induced emesis. A multicentre, double-blind, randomised, parallel group study. Br J Cancer 1992; 66: 192–7

    Article  PubMed  CAS  Google Scholar 

  19. Beck TM, Hesketh PJ, Madajewicz, et al. Stratified, randomized, double-blind comparison of intravenous ondansetron administered as a multiple-dose regimen versus two singledose regimens in the prevention of cisplatin-induced nausea and vomiting. J Clin Oncol 1992; 10: 1969–75

    PubMed  CAS  Google Scholar 

  20. Marty M, d’Allens H. Etude randomisee en double-insu comparant l’efficacite de l’ondansetron selon deux modes d’administration: injection unique et perfusion continue. Cahiers Cancer 1990; 2: 541–6

    Google Scholar 

  21. Hesketh PJ, Beck TM, Uhlenhopp M, et al. Adjusting the dose of intravenous ondansetron plus dexamethasone to the emetogenic potential of the chemotherapy regimen. J Clin Oncol 1995; 13: 2117–22

    PubMed  CAS  Google Scholar 

  22. Hesketh PJ, Harvey WH, Harker WG, et al. 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 1994; 12 (3): 596–600

    PubMed  CAS  Google Scholar 

  23. Riola F, Tonato M, Cognetti F, et al. Prevention of cisplatininduced emesis: a double-blind multicenter randomized crossover study comparing ondansetron and ondansetron plus dexamethasone. J Clin Oncol 1991; 9 (4): 675–8

    Google Scholar 

  24. Smyth JF, Coleman RE, Nicolson M, et al. Does dexamethasone enhance control of acute cisplatin induced emesis by ondansetron? BMJ 1991; 303 (6815): 1423–6

    Article  PubMed  CAS  Google Scholar 

  25. Joss RA, Bacchi M, Buser K, et al. Ondansetron plus dexamethasone is superior to ondansetron alone in the prevention of emesis in chemotherapy-na‹ve and previously treated patients. Ann Oncol 1994; 5: 253–8

    PubMed  CAS  Google Scholar 

  26. Lofters W, Pater J, Zee B, et al. Phase III double-blind comparison of dolasetron mesylate and ondansetron: an evaluation of the additive role of dexamethasone in the prevention of emetogenic chemotherapy. J Clin Oncol 1997; 15 (8): 2966–73

    PubMed  CAS  Google Scholar 

  27. Alvarez O, Freeman A, Bedros A, et al. A randomized doubleblind crossover of ondansetron-dexamethasone versus ondansetron- placebo study for the treatment of chemotherapy induced nausea and vomiting in pediatric patients with malignancies. Am J Pediatr Hematol Oncol 1995; 17: 145–50

    Article  CAS  Google Scholar 

  28. Italian Group for Antiemetic Research. Dexamethasone, granisetron, or both for the prevention of nausea and vomiting during chemotherapy for cancer. N Engl JMed 1995; 332: 1–5

    Article  Google Scholar 

  29. DuBois A, McKenna CJ, Andersson H, et al. A randomized, double-blind, parallel-group study to compare the efficacy and safety of ondansetron (GR38032F) plus dexamethasone with metoclopramide plus dexamethasone in the prophylaxis of nausea and emesis by carboplatin chemotherapy. Oncology 1997; 54: 7–14

    Article  CAS  Google Scholar 

  30. Markman M, Kennedy A, Webster K, et al. Low-dose intravenous ondansetron (8 mg) plus dexamethasone: an effective regimen for the control of carboplatin-induced emesis. J Cancer Res Clin Oncol 1997; 123: 224–6

    PubMed  CAS  Google Scholar 

  31. DiPiro CV, Sanal SM, Harkness KT, et al. The antiemetic efficacy of intravenous ondansetron (OND) at conventional versus lowdose in womenwith early stage breast cancer [abstract 1752]. Proc Am Soc Clin Oncol 1996; 15: 54

    Google Scholar 

  32. Kaizer L, Warr D, Hoskins P, et al. 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 Trial Group. J Clin Oncol 1994; 12: 1050–7

    PubMed  CAS  Google Scholar 

  33. Bonneterre J, Hecquet B. Granisetron IV compared with ondansetron IV plus tablets in the prevention of nausea and vomiting induced by a moderately emetogenic chemotherapy regimen: a randomized cross-over study. Presented at the European Conference on Clinical Oncology; 1993 Nov 14; Jerusalem

  34. Jantunen IT, Muhonen TT, Kataja VV, et al. 5HT3 receptor antagonists in the prophylaxis of acute vomiting induced by moderately emetogenic chemotherapy-a randomised study. Eur J Cancer 1993; 29A: 1669–92

    Article  Google Scholar 

  35. Massidda B, Ionta MT. The 5-HT3-receptor antagonists in the prevention of acute and delayed emesis induced by standard or accelerated chemotherapy for breast cancer [abstract 106]. Support Care Cancer 1996; 4 (3): 250

    Google Scholar 

  36. Spector JI, Lester EP, Chevlen EM. A comparison of oral ondansetron and intravenous granisetron for the prevention of nausea and emesis associated with cisplatin-based chemotherapy. Oncologist 1998; 3: 432–8

    PubMed  CAS  Google Scholar 

  37. Krzakowski M, Graham E, Goedhals L, et al. A multicenter, double-blind comparison of i.v. and oral administration of ondansetron plus dexamethasone for acute cisplatin-induced emesis. Anticancer Drugs 1998; 9: 593–8

    Article  PubMed  CAS  Google Scholar 

  38. Lindley C, McCune J, Goodin S, et al. Efficacy of oral ondansetron and dexamethasone in prevention of nausea and vomiting associatedwith moderately-high and highly emetogenic chemotherapy [abstract 244]. Proc AmSoc Clin Oncol 1998; 17: 63a

    Google Scholar 

  39. Needles B, Miranda E, Garcia Rodriguez FM, et al. A multicenter, double-blind, randomized comparison of oral ondansetron 8mg b.i.d., 24mg q.d., and 32mg q.d. in the prevention of nausea and vomiting associated with highly emetogenic chemotherapy. Support Care Cancer 1999; 7 (5): 347–53

    Article  PubMed  CAS  Google Scholar 

  40. Franchi M, Donadello N, Zanaboni F, et al. Oral ondansetron and intravenous dexamethasone in the prevention of cisplatininduced emesis. Oncology 1995; 52: 509–12

    Article  PubMed  CAS  Google Scholar 

  41. Beck T, York M, Chang A, et al. Oral ondansetron 8 mg bid is as effective as 8 mg tid in prevention of nausea and vomiting associated with moderately emetogenic cancer chemotherapy. Cancer Invest 1997; 15 (4): 297–303

    Article  PubMed  CAS  Google Scholar 

  42. Data on file. Protocol S3A-376. Research Triangle Park (NC): GlaxoWellcome, Inc., 1994

  43. Tsavaris NB, Tsaroucha-Noutsou E, Karvounis N, et al. Comparison of different schedules of ondansetron (GR 38032F) administration during cisplatin-based chemotherapy; a randomized trial. Chemotherapy 1995; 41 (1): 70–6

    Article  PubMed  CAS  Google Scholar 

  44. DiBartolomero M, Bajetta E, Biganzoli L, et al. Control of emesis by a low dose of ondansetron and dexamethasone. Tumori 1994; 80 (2): 131–4

    Google Scholar 

  45. DiBenedetto J, Cubeddu L, Ryan T, et al. Ondansetron for nausea and vomiting associatedwith moderately emetogenic cancer chemotherapy. Clin Ther 1995; 17 (6): 1091–8

    Article  PubMed  Google Scholar 

  46. Data on file. Protocol OND A0801. Research Triangle Park (NC): GlaxoWellcome, Inc., 1994

  47. Dicato MA. Oral treatment with ondansetron in an outpatient setting. Eur J Cancer 1991; 27 Suppl.: S18–9

    Google Scholar 

  48. Smith DB, Newlands ES, Rustin GJS, et al. Comparison of ondansetron and ondansetron plus dexamethasone as antiemetic prophylaxis during cisplatin-containing chemotherapy. Lancet 1991; 338: 487–90

    Article  PubMed  CAS  Google Scholar 

  49. Yilmaz UM, Utkaner G, Yukel M, et al. Ondansetron tablet plus dexamethasone in the prophylaxis of acute emesis and nausea associated with low or high dose cisplatin-based chemotherapy in lung cancer: double-blind comparative, consecutive study [abstract 819]. Lung Cancer 1997; 18 Suppl. 1: 211

    Article  Google Scholar 

  50. Campora E, Chiara S, Aschele C. Ondansetron for the control of dacarbazine-induced emesis. Eur J Cancer 1995; 31A(10): 1720–1

    Article  Google Scholar 

  51. Small BE, Holdsworth MT, Raisch DW, et al. Survey ranking of emetogenic control in children receiving chemotherapy. J Pediatr Hematol Oncol 2000; 22 (2): 125–32

    Article  PubMed  CAS  Google Scholar 

  52. Brock P, Brichard B, Rechnitzer C, et al. An increased loading dose of ondansetron: a North European, double-blind randomised study in children, comparing 5 mg/m2with 10 mg/m2. Eur J Cancer 1996; 32A: 1744–8

    Article  Google Scholar 

  53. Holdsworth MT, Raisch DW, Duncan MH, et al. Assessment of chemotherapy induced emesis and evaluation of a reduceddose intravenous ondansetron regimen in pediatric outpatients with leukemia. Ann Pharmacother 1995; 29: 16–21

    PubMed  CAS  Google Scholar 

  54. Holdsworth MT, Raisch DW, Winter SS, et al. Assessment of the emetogenic potential of intrathecal chemotherapy and response to prophylactic treatment with ondansetron. Support Care Cancer 1998; 6: 132–8

    Article  PubMed  CAS  Google Scholar 

  55. Product information. Kytrilrinjectable/tablets. Philadelphia (PA): SmithKline Beecham Pharmaceuticals, 1999 Jun

  56. Plosker GL, Goa KL. Granisetron: a review of its pharmacological properties and therapeutic use as an antiemetic. Drugs 1991; 42 (5): 805–24

    Article  PubMed  CAS  Google Scholar 

  57. Yarker YE, McTavish D. Granisetron: an update of its therapeutic use in nausea and vomiting induced by antineoplastic therapy. Drugs 1994; 48 (5): 761–93

    Article  PubMed  CAS  Google Scholar 

  58. Navari RM, Kaplan HG, Gralla RJ, et al. 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 1994; 12: 2204–10

    PubMed  CAS  Google Scholar 

  59. Riviere A, Granisetron Study Group. Dose finding study of granisetron in patients receiving high-dose cisplatin chemotherapy. Br J Cancer 1994; 69: 967–71

    Article  PubMed  CAS  Google Scholar 

  60. Perez EA, Lembersky B, Kaywin P, et al. Intravenous (IV) granisetron vs ondansetron in the prevention of cyclophosphamide- doxorubicin-induced emesis in breast cancer patients: a double-blind crossover study [abstract 1764]. Proc Am Soc Clin Oncol 1996; 15: 542

    Google Scholar 

  61. Navari RM, Hesketh P, Hall S, et al., Granisetron Study Group. Comparative clinical trial of granisetron and ondansetron in the prophylaxis of cisplatin-induced emesis. J Clin Oncol 1995; 13: 1242–8

    PubMed  CAS  Google Scholar 

  62. Kamanabrou D. Intravenous granisetron - establishing the optimal dose. Eur J Cancer 1992; 28 Suppl. 1: S6-S11

    Article  Google Scholar 

  63. Soukop M, Granisetron Study Group. A comparison of two dose levels of granisetron in patients receiving high-dose cisplatin. Eur J Cancer 1990; 26 Suppl. 1: S15-S19

    Google Scholar 

  64. Smith IE, Granisetron Study Group. A comparison of two dose levels of granisetron in patients receiving moderately emetogenic cytostatic chemotherapy. Eur J Cancer 1990; 26 Suppl. 1: S19-S23

    Google Scholar 

  65. Marty M, Granisetron Study Group. Acomparison of granisetron as a single agent with conventional combination antiemetic therapies in the treatment of cytostatic-induced emesis. Eur J Cancer 1992: 28A Suppl. 1: S12-S16

    Google Scholar 

  66. Roila F, Italian Group for Antiemetic Research. Ondansetron versus granisetron, both combined with dexamethasone, in the prevention of cisplatin-induced emesis. Ann Oncol 1995; 6 (8): 805–10

    Google Scholar 

  67. Bleiberg HH, Spielmann M, Falkson G, et al. Antiemetic treatment with oral granisetron in patients receiving moderately emetogenic chemotherapy: a dose-ranging study. Clin Ther 1995: 17: 38–51

    Article  PubMed  CAS  Google Scholar 

  68. Dott C. Comparison of the efficacy of oral granisetron alone and with dexamethasone: a conventional antiemetic treatment for the prevention of nausea and vomiting for 24 hours following cisplatin treatment [abstract]. Proc Am Soc Clin Oncol 1993; 12A: 1602

    Google Scholar 

  69. Heron JF, Goedhals L, Jordaan JP, et al. 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. The Granisetron Study Group. Ann Oncol 1994; 5 (7): 579–84

    PubMed  CAS  Google Scholar 

  70. Gralla RJ, Rittenberg CN, Lettow LA, et al. A unique, all-oral, single-dose, combination antiemetic regimen with high efficacy and marked cost-savings potential [abstract 1730]. Proc Am Soc Clin Oncol 1995: 14: 526

    Google Scholar 

  71. Markman M, Kennedy A, Webster K, et al. Low dose oral granisetron (1mg) plus intravenous dexamethasone: efficacy in gynecologic cancer patients receiving carboplatin-based chemotherapy. Gynecol Oncol 1998; 71: 113–5

    Article  PubMed  CAS  Google Scholar 

  72. Hesketh PJ, Crews JR, Cohen R, et al. Efficacy of a single 1-mg OR 2-mg dose of oral granisetron for the prevention of nausea and vomiting induced by IV cyclophosphamide or carboplatinbased chemotherapy regimens [abstract]. Proc Am Soc Clin Oncol 1999: A2290

  73. Martin JK, Senecal FM, Baker TM, et al. Single-dose 1mg oral granisetron is less costly and as effective as intravenous ondansetron in controlling nausea and vomiting from moderately emetogenic chemotherapy [abstract]. Proc Am Soc Clin Oncol 1997: A262

  74. Heron JF. Pilot studies with oral granisetron in cisplatin-treated patients [abstract]. Proceedings of the 15th International Cancer Congress; 1990 Aug 16–22; Hamburg, 28–30

  75. Perez EA, Hesketh P, Sanbach J, et al. Comparison of single dose oral granisetron versus intravenous ondansetron in the prevention of nausea and vomiting induced by moderately emetogenic chemotherapy: a multicenter, double-blind, randomized parallel study. J Clin Oncol 1998; 16: 754–60

    PubMed  CAS  Google Scholar 

  76. Gralla RJ, Navari RM, Hesketh PJ, et al. Single dose oral granisetron has equivalent antiemetic efficacy to intravenous ondansetron for highly emetogenic cisplatin-based chemotherapy. J Clin Oncol 1998; 16: 1568–73

    PubMed  CAS  Google Scholar 

  77. Lemerle J, Amaral D, Southall DP, et al. Efficacy and safety of granisetron in the prevention of chemotherapy-induced emesis in paediatric patients. Eur J Cancer 1991; 27: 1081–3

    Article  PubMed  CAS  Google Scholar 

  78. Leclerc JM, Jacobson SJ, Cohn R, et al. A double-blind doseranging study of IV granisetron in children undergoing highly emetogenic chemotherapy [abstract]. Proc Am Soc Clin Oncol 1993; 12: 437

    Google Scholar 

  79. Tsuchida Y, Hayashi Y, Asami K, et al. Effects of granisetron in children undergoing high-dose chemotherapy: a multi-institutional, cross-over study. Int J Oncol 1999; 14: 673–9

    PubMed  CAS  Google Scholar 

  80. Product information. Anzemetr. Kansas City (MO): Hoechst Marion Roussel, 1997

  81. Kris, MG, Grunberg SM, Gralla RJ, et al. Dose-ranging evaluation of the serotonin antagonist dolasetron mesylate in patients receiving high dose cisplatin. J Clin Oncol 1994; 12: 1045–9

    PubMed  CAS  Google Scholar 

  82. Hesketh P, Navari R, Grote T, et al. Double-blind, randomized comparison of the antiemetic efficacy of intravenous dolasetron mesylate and intravenous ondansetron in the prevention of acute cisplatin induced emesis in patients with cancer. J Clin Oncol 1996; 14: 2242–9

    PubMed  CAS  Google Scholar 

  83. Audhuy B, Cappelaere P, Martin M, et al. A double blind, randomised comparison of the anti-emetic efficacy of two intravenous doses of dolasetron mesylate and granisetron in patients receiving high dose cisplatin chemotherapy. Eur J Cancer 1996; 32A: 807–13

    Article  Google Scholar 

  84. Whitmore JB, Kris MG, Hesketh PJ, et al. Rationale for the use of a single fixed intravenous dolasetron dose for the prevention of cisplatin-induced nausea and vomiting. Pooled analysis of 14 clinical trials. Support Care Cancer 1998; 6: 473–8

    Article  PubMed  CAS  Google Scholar 

  85. Rubenstein EB, Gralla RJ, Hainsworth JD, et al. Randomized, double blind, dose-response trial across four oral doses of dolasetron for the prevention of acute emesis aftermoderately emetogenic chemotherapy. Cancer 1997; 79: 1216–24

    Article  PubMed  CAS  Google Scholar 

  86. Fauser AA, Duclos B, Chemaissani A, et al. Therapeutic equivalence of single oral doses of dolasetronmesilate and multiple doses of ondansetron for the prevention of emesis after moderately emetogenic chemotherapy. Eur J Cancer 1996; 32A: 1523–9

    Article  Google Scholar 

  87. Kris MG, Pendergrass KB, Navari RM, et al. Prevention of acute emesis in cancer patients following high dose cisplatin with the combination of oral dolasetron and dexamethasone. J Clin Oncol 1997; 15: 2135–8

    PubMed  CAS  Google Scholar 

  88. Leclerc JM, Greenberg M, Lau R, et al. Open label IV dolasetron mesylate in pediatric patients receiving moderately to highly emetogenic chemotherapy: pharmacokinetics, efficacy and safety [abstract]. Support Care Cancer 1995; 3: 343

    Google Scholar 

  89. Yanofsky R, Pyesmany A, Pritchard S, et al. Open label oral dolasetron mesylate in pediatric patients receiving moderately to highly emetogenic chemotherapy: pharmacokinetics, efficacy and safety [abstract]. Support Care Cancer 1995; 3: 344

    Google Scholar 

  90. Johnson NE, Nash DB, Carpenter CE, et al. Ondansetron: costs and resource utilisation in a US teaching hospital setting. Pharmacoeconomics 1993; 3 (6): 471–81

    Article  PubMed  CAS  Google Scholar 

  91. Cunningham D, Gore M, Davidson N, et al. The real cost of emesis - an economic analysis of ondansetron vs metoclopramide in controlling emesis in patients receiving chemotherapy for cancer. Eur J Cancer 1990; 29A: 303–6

    Article  Google Scholar 

  92. Cox F, Hirsh J. Ondansetron: a cost-effective advance in antiemetic therapy. Oncology 1993; 50: 186–90

    Article  PubMed  CAS  Google Scholar 

  93. Jones AL, Lee GJ, Bosanquet N. The budgetary impact of 5- HT3 receptor antagonists in the management of chemotherapy- induced emesis. Eur J Cancer 1993; 29A: 51–6

    Article  Google Scholar 

  94. Dranitsaris G, De Angelis C, Warr D, et al. Pharmacoeconomic analysis of prophylactic treatments for emesis secondary to breast cancer chemotherapy. Can J Hosp Pharm 1995; 48: 266–75

    Google Scholar 

  95. Sanchez LA, Bartel S. Application of pharmacoeconomics to develop and justify drug use guidelines. New Med 1998: 2: 225–31

    Google Scholar 

  96. Nolte MJ, Berkery R, Pizzo B, et al. Assuring the optimal use of serotonin antagonist antiemetics: process for development and implementation of institutional antiemetic guidelines at Memorial Sloan-Kettering Cancer Center. J Clin Oncol 1998; 16: 771–8

    PubMed  CAS  Google Scholar 

  97. Stewart DJ, Dahrouge S, Coyle D, et al. Costs of treating and preventing nausea and vomiting in patients receiving chemotherapy. J Clin Oncol 1999; 17: 344–51

    PubMed  CAS  Google Scholar 

  98. Lachaine J, Laurier C, Langleben A, et al. Cost-effectiveness and quality of life evaluation of ondansetron and metoclopramide for moderately emetogenic chemotherapy regimens in breast cancer. Crit Rev Oncol Hematol 1999: 32: 105–12

    Article  PubMed  CAS  Google Scholar 

  99. Johnson N, Bosanquet N. Cost effectiveness of 5-hydroxytryptamine- 3 receptor antagonists: a retrospective comparison of ondansetron and granisetron. Anticancer Drugs 1995; 6: 243–9

    Article  PubMed  CAS  Google Scholar 

  100. Dana WJ. 5-HT3-receptor antagonists in the management of emesis: pharmacoeconomic issues. Hosp Formul 1994; 29 Suppl. 5: S24–8

    Google Scholar 

  101. Buxton MJ, O’Brien BJ. Economic evaluation of ondansetron: preliminary analysis using clinical trial data prior to price setting. Br J Cancer 1992: 66 Suppl. 19: S64-S67

    Google Scholar 

  102. Tanneberger S, Lelli G, Martoni A, et al. The antiemetic efficacy and cost-benefit ratio of ondansetron calculated with a new health approach to health technology assessment (real cost-benefit index). J Chemother 1992: 4 (5): 326–31

    PubMed  CAS  Google Scholar 

  103. Grunberg SM. Cost-effective use of antiemetics. Oncology 1998; 12 Suppl. 4: 38–42

    PubMed  CAS  Google Scholar 

  104. Lindley CM, Hirsch JD, O’Neill CV, et al. Quality of life consequences of chemotherapy-induced emesis. Qual Life Res 1992; 1: 331–40

    Article  PubMed  CAS  Google Scholar 

  105. Berry WR, House KW, Lee JT, et al. Results of a compassionate use program using intravenous ondansetron to prevent nausea and vomiting in patients receiving emetogenic cancer chemotherapy. Semin Oncol 1992; 19 (6): S33–7

    PubMed  CAS  Google Scholar 

  106. Kaasa S. Measurement of quality of life in clinical trials. Oncology 1992; 49: 288–94

    Article  Google Scholar 

  107. Grunberg SM, Boutin N, Ireland A, et al. Impact of nausea/vomiting on quality of life as a visual analogue scale-derived utility score. Support Care Cancer 1996; 4: 435–9

    Article  PubMed  CAS  Google Scholar 

  108. American Society of Health-SystemPharmacists (ASHP)Commission on Therapeutics. ASHP Therapeutic Guidelines on the pharmacologic management of nausea and vomiting in adult and pediatric patients receiving chemotherapy or radiation therapy or undergoing surgery. Am J Health Syst Pharm 1999; 56: 729–64

    Google Scholar 

  109. 1998Drug Topics Red Book. 102nd ed.Montvale (NJ):Medical Economics Co., 1998

  110. Pharmaceutical care in oncology. Clinical brief number 1; antiemetic therapy. Meeting Symposium, 1995

  111. Gandara DR, Roila F, Warr D, et al. Consensus proposal for 5HT3 antagonists in the prevention of acute emesis related to highly emetogenic chemotherapy. Dose, schedule, and route of administration. Support Care Cancer 1998; 6 (3): 237–43

    Article  PubMed  CAS  Google Scholar 

  112. Gralla RJ, Osoba D, Kris M, et al. Recommendations for the use of antiemetics: evidence-based clinical practice guidelines. J Clin Oncol 1999; 17: 2971–94

    PubMed  CAS  Google Scholar 

Download references

Acknowledgements

The authors would like to acknowledge the drug information assistance of Kelley Curtis, R.Ph., Director of Drug Information, Brigham and Women’s Hospital, Boston, Massachusetts, USA, and the clinical experience of Jim Wood, PharmD, BCOP, Senior Regional Medical Scientist, GlaxoWellcome Inc. Additionally, we would like to thank the Drug Information Departments of GlaxoWellcome Inc., Hoechst Marion Roussel and SmithKline Beecham Pharmaceuticals.

Author information

Authors and Affiliations

  1. PE Applications, Inc., 51 Mt Vernon Street, #1, Boston, Massachusetts, 02108, USA

    Lisa A. Sanchez

  2. Department of Pharmacy Practice, University of New Mexico, Albuquerque, New Mexico, USA

    Mark Holdsworth

  3. Department of Pharmacy, Dana Farber Cancer Institute, Boston, Massachusetts, USA

    Sylvia B. Bartel

Authors
  1. Lisa A. Sanchez
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mark Holdsworth
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sylvia B. Bartel
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Lisa A. Sanchez.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Sanchez, L.A., Holdsworth, M. & Bartel, S.B. Stratified Administration of Serotonin 5-HT3 Receptor Antagonists (Setrons) for Chemotherapy-Induced Emesis. Pharmacoeconomics 18, 533–556 (2000). https://doi.org/10.2165/00019053-200018060-00002

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/00019053-200018060-00002

Keywords

Search

Navigation