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Comparison of the efficacy of tropisetron versus a metoclopramide cocktail based on the intensity of cisplatin-induced emesis

  • Tropisetron, Metoclopramide Cocktail, Cisplatin-Induced Emesis
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Abstract

Cisplatin-induced emesis is one of the most feared side effects in cancer treatment. High-dose metoclopramide may prevent only 30–40% of cases of acute emesis. Investigations to test the efficacy of new antiemetics are mandatory. We compared the efficacy, toxicity, and patients' preference for tropisetron, a new 5-hydroxytryptamine3 (HT3) receptor antagonist, with those of a combination of high-dose metoclopramide, dexamethasone, diphenhydramine, and lorazepam (metoclopramide cocktail) in a randomized crossover study for the control of nausea and vomiting during cisplatin-containing chemotherapy. A total of 62 chemotherapy-naive women were included and followed over 3 consecutive courses. Detailed analysis comparing the incidence of acute emesis for each 4 h period following cisplatin infusion was also performed. Complete protection from acute emesis was obtained in 48% of patients receiving tropisetron and 29% of patients receiving the metoclopramide cocktail over the first two courses of chemotherapy (P=0.029). When the frequency of acute emesis in all patients was compared on a daily basis, no significant difference was found. When emesis frequency was compared over each 4 h period following infusion of cisplatin, tropisetron was superior to the metoclopramide cocktail during the first, the second, and the first and second periods (P=0.0001,P=0.01 andP=0.0006, respectively). This superiority reversed after 12 h but did not reach statistical significance (P=0.112). Tropisetron was more effective in controlling acute nausea, but metoclopramide provided better control of delayed emesis. A drop in efficacy over successive courses was observed in patients receiving metoclopramide first but was not seen in tropisetron-first patients. A tendency for tropisetron preference was observed. Tropisetron is more effective than the metoclopramide cocktail in the control of chemotherapy-induced vomiting within 8 h of the implementation of cisplatin and in the control of nausea on the 1st day. To improve the control of chemotherapy-induced emesis, further investigations on the additional tropisetron dosing at 8 h after cisplatin infusion or the combination use of tropisetron and other antiemetics by a continuous 4 h period of observation and comparison are mandatory.

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Authors and Affiliations

  1. Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou, 333, Taoyuan, Taiwan

    Ting-Chang Chang, Chyong-Huey Lai, Chih-Jen Tseng, Huei-Hsin Cheng, Chia-Lin Li & Yoong-Kuei Soong

  2. Institute of Statistics, National Tsing Hua University, Hsinchu, Taiwan

    Fushing Hsieh

  3. Department of Primary Care Medicine, Chang Gung Medical College, Taoyuan, Taiwan

    Bullard J. Michael

Authors
  1. Ting-Chang Chang
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  2. Fushing Hsieh
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  3. Chyong-Huey Lai
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  4. Chih-Jen Tseng
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  5. Huei-Hsin Cheng
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  6. Chia-Lin Li
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  7. Bullard J. Michael
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  8. Yoong-Kuei Soong
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This work was supported in part by Sandoz Pharmaceuticals Ltd., Taiwan Branch

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Chang, TC., Hsieh, F., Lai, CH. et al. Comparison of the efficacy of tropisetron versus a metoclopramide cocktail based on the intensity of cisplatin-induced emesis. Cancer Chemother. Pharmacol. 37, 279–285 (1995). https://doi.org/10.1007/BF00688329

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  • DOI: https://doi.org/10.1007/BF00688329

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