Management of highly emetogenic chemotherapy. [Curr Opin Oncol. 2012] - PubMed - NCBI
Definition for emetogenic:
Web definitions: |
Vomiting
(known medically as emesis and informally as throwing up and a number
of other terms) is the forceful expulsion of the contents...
en.wikipedia.org/wiki/Emetogenic
|
|
~~~~~~~~~~~~~~~~~~
Abstract
PURPOSE OF REVIEW:
This review updates the clinical data on antiemetic therapy for chemotherapy classified as highly emetogenic.
RECENT FINDINGS:
A
meta-analysis demonstrated that
palonosetron was superior to other
5-hydroxytryptamine3 (5-HT3) receptor antagonists at least in the
absence of aprepitant. Two major guideline groups have
reclassified all
chemotherapy that contains
cyclophosphamide and an anthracycline as
'highly emetogenic'. Although recommended prophylaxis for drugs in that
category includes aprepitant, phase II studies with cyclophosphamide,
doxorubicin, vincristine and prednisone (CHOP) and doxorubicin,
bleomycin, vincristine and dacarbazine (ABVD) demonstrated that
single
agent palonosetron alone provided control of emesis over 85% of
patients. A randomized phase III trial of olanzapine versus aprepitant
found that the control of emesis was similar and nausea was
significantly better controlled with olanzapine. Two studies showed that
there is no impact of the moderate cytochrome P450 3A4 (CYP3A4)
inhibitor aprepitant on the pharmacokinetics of cyclophosphamide.
Surveys in the United States and Europe demonstrated that antiemetic
prescribing practices often do not adhere to guidelines even for highly
emetogenic chemotherapy.
SUMMARY:
The major guideline
groups recommend a combination of a 5-HT3 receptor antagonist,
dexamethasone and aprepitant ('triple therapy') for treatment
categorized as highly emetogenic. Recent data suggest that, although
classified as highly emetogenic,
palonosetron may provide very good
control of emesis for CHOP and ABVD.
Guidelines have not made firm
recommendations for highly emetogenic chemotherapy administered over
several days or stem cell transplant preparative regimens due to the
lack of published randomized trials. Although well tolerated and
effective, many patients receive
suboptimal antiemetic therapy that
includes aprepitant.
0 comments :
Post a Comment
Your comments?
Note: Only a member of this blog may post a comment.