Radiation Oncology/Supportive care/Nausea



Supportive Care for Nausea and Vomiting


Ematogenicity PotentialEdit

  • ASCO; 1997 PMID 8996130 -- "Proposal for classifying the acute emetogenicity of cancer chemotherapy." (Hesketh PJ, J Clin Oncol. 1997 Jan;15(1):103-9.)
    • Review of clinical trials. Chemotherapy agents divided into 5 levels
Class Ematogenicity Drugs
I <10% Bleomycin, Busulfan, Chlorambucil (oral), Fludarabine, Hydroxyurea, MTX <50 mg/m2, Mustard gas, Thioguanine (oral), Vinblastine, Vincristine, Vinorelbine
II 10-30% Docetaxel, Etoposide, 5-FU <1000 mg/m2, Gemcitabine, MTX 5-250 mg/m2, Mitomycin, Paclitaxel
III 30-60% Cyclophosphamide <750 mg/m2, Cyclophosphamide (oral), Daxorubicin <60 mg/m2, Epirubicin <90 mg/m2, Idarubicin, Ifosfamide, MTX 250-1000 mg/m2, Mitoxantrone <15 mg/m2
IV 60-90% Carboplatin, Carmustine <250 mg/m2, Cisplatin <50 mg/m2, Cyclophosphamide 750-1500 mg/m2, Cytarabine > 1000 mg/m2, Daxorubicin >60 mg/m2, MTX >1000 mg/m2, Procarbazine (oral)
V >90% Carmustine >250 mg/m2, Cisplatin >50 mg/m2, Cyclophosphamide >1500 mg/m2, Dacarbazine, Mechlorethamie, Streptozocin


5-HT3 antagonistsEdit

  • Ondansetron (Zofran)
  • Granisetron (Kytril)
  • Dolasetron (Anzemet)
  • Palonosetron (Aloxi) - IV, 0.25 mg


  • Umea; 1996 (Sweden) PMID 8879372 -- "A randomised placebo controlled study with ondansetron in patients undergoing fractionated radiotherapy." (Franzen L, Ann Oncol. 1996 Aug;7(6):587-92.)
    • Randomized. 111 patients, abdominal RT, at least 10 fractions. Used [EORTC C30] questionnaire
    • Outcome: complete control of emesis ondansetron 67% vs. placebo 45% (SS). Number of emetic episodes on worst day 1.4 vs. 3.1 (SS), also fewer days with emesis for ondansetron. Benefit during week 1-3, not after
    • Conclusion: Prophylactic ondansetron effective in preventing N/V in abdominal RT


NK-1 antagonistsEdit

  • Aprepitant (Emend) - PO


  • Aprepitant Protocol 052
    • 2003 PMID 14559886 -- "The oral neurokinin-1 antagonist aprepitant for the prevention of chemotherapy-induced nausea and vomiting: a multinational, randomized, double-blind, placebo-controlled trial in patients receiving high-dose cisplatin--the Aprepitant Protocol 052 Study Group." (Hesketh PJ, J Clin Oncol. 2003 Nov 15;21(22):4112-9. Epub 2003 Oct 14.)
    • Randomized. 530 patients, receiving cisplatin >=70 mg/m2 for first time. Arm 1) standard therapy (ondansetron + dexamethasone) vs. Arm 2) aprepitant + standard therapy. N/V episodes recorded in diary. CR defined as no emesis on days 1-5
      • Outcome: CR standard 52% vs. aprepitant + standard 73% (SS)
      • Conclusion: Addition of aprepitant provided superior protection against chemotherapy-induced nausea and vomiting
Last modified on 11 May 2008, at 00:35