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OBJECTIVE@#To investigate the correlation between aldehyde dehydrogenase 2 (ALDH2) rs671 polymorphisms and chemotherapy-induced nausea and vomiting (CINV).@*METHODS@#A total of 90 Chinese patients with malignant tumors receiving chemotherapy for the first time were recruited in this study. The occurrence of CINV was observed within 120 h after treatment with docetaxel and cis-platinum chemotherapy (DP regimen). The data of the patients (including age, gender, tumor stage, habitual alcohol consumption, motion sickness, morning sickness, and average sleep time prior to chemotherapy) were collected through a questionnaire. ALDH2 rs671 polymorphisms of the patients were analyzed using a multiple single nucleotide polymorphism genotyping, and the Hardy-Weinberg equation was used for genetic linkage analysis. The correlations between the factors including ALDH2 rs671 polymorphisms and the occurrence of CINV were analyzed.@*RESULTS@#The incidence of CINV was 48.9% among the patients receiving their first chemotherapy with DP regimen. Univariate analysis indicated that the genetic polymorphisms of ALDH2 rs671 were significantly correlated with the occurrence of CINV (P < 0.05). Multivariate logistic analysis indicated that ALDH2 rs671 mutation (OR: 3.019, 95% CI: 1.056-8.628, P < 0.05) and average sleep time prior to chemotherapy no longer than 6 h (OR: 2.807, 95% CI: 1.033-7.628, P < 0.05) were risk factors for CINV in patients with malignant tumors receiving the first chemotherapy with DP regimen.@*CONCLUSION@#ALDH2 gene mutation at rs671 is a risk factor contributing to the occurrence of CINV, and understanding of the underlying mechanism may help to more effectively control the occurrence of CINV.
Subject(s)
Humans , Aldehyde Dehydrogenase, Mitochondrial/genetics , Antineoplastic Agents/adverse effects , Nausea/genetics , Polymorphism, Single Nucleotide , Vomiting/genetics , Neoplasms/drug therapyABSTRACT
OBJECTIVE：To provide reference for clinical decision-making related to chemotherapy-induced nausea and vomiting（CINV）. METHODS ：The medical records of patients diagnosed as malignant tumor receiving multi-day cisplatin-containing chemotherapy in our hospital were collected by hospital information system from Jan.-Dec. 2012. The medical records were divided into tropisetron group ，ramosetron group and palonosetron group according to different schemes of 5-hydroxytryptamine-3 receptor antagonist. The covariates of 3 groups were balanced by propensity score matching method ；cost-utility analysis was conducted for the 3 matched antiemetic schemes ；one-way sensitivity analysis and sampling uncertainty analysis were also conducted. RESULTS ： The results of cost-utility analysis showed that treatment cost of one observation period of tropisetron group was 237.71 yuan and utility were 0.054 68 QALYs；that of ramosetron group was 242.37 yuan and utility were 0.055 26 QALYs，and that of palonosetron group was 319.24 yuan and utility were 0.055 76 QALYs. Compared with tropisetron group ，the ICER of palonosetron group was 75 155.69 yuan/QALY；Compared with ramosetron group ，the ICER of palonosetron group was 152 062.07 yuan/QALY. Both of them were lower than 3 times of China ’s 2020 per capita GDP （217 341 yuan/QALY）. The results of sensitivity analysis and sampling uncertainty analysis demonstrated that the results of basic analysis were robust. CONCLUSIONS ：Under the current drug price，the antiemetic regimen based on palonosetron is more economical for the prevention of CINV caused by multi-day chemotherapy containing cisplatin.
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BACKGROUND@#The side effects of chemotherapy-induced nausea and vomiting (CINV) and myelosuppression reduce the cancer patients' adherence to chemotherapy. Many Chinese patients choose Chinese medicine (CM) during chemotherapy to reduce side effects; however, the evidence is lacking. The efficacy of a CM herbal treatment protocol, Jianpi Bushen Sequential Formula (, JBSF) will be evaluated on chemotherapy completion rate among patients with colon cancer.@*METHODS@#A multi-center double-blind randomized controlled trial (RCT) will be conducted on 400 patients with colon cancer who will receive 8 cycles of adjuvant chemotherapy with oxaliplatin and capecitabine (CAPEOX). Patients will be randomized 1:1 to receive the JBSF or placebo formula. The primary outcome is the overall chemotherapy completion rate. The secondary outcomes include individual chemotherapy completion rate, 4-cycle completion rate of chemotherapy, time to treatment failure, relative dose intensity and treatment toxicity. Follow-up visits will be scheduled before every and after last chemotherapy.@*DISCUSSION@#This study will provide evidence on whether JBSF can improve the chemotherapy completion rate and reduce side effects among patients with colon cancer. (Trial registration: ClinicalTrials.gov, No. NCT03716518).
Subject(s)
Humans , Chemotherapy, Adjuvant , Colonic Neoplasms/drug therapy , Double-Blind Method , Multicenter Studies as Topic , Nausea , Quality of Life , Randomized Controlled Trials as Topic , Treatment Outcome , VomitingABSTRACT
Tumors pose a great threat to human health. As a systemic treatment, chemotherapy has held an unshakable position in tumor treatment. Chemotherapy induced nausea and vomiting (CINV) is a common adverse reaction during chemotherapy, which seriously affects patients' mood, quality of life and tumor control. The prevention and treatment of CINV is very important for cancer patients. As a more commonly used 5-HT3 receptor antagonist, tropisetron has a good clinical effect in the prevention and treatment of CINV. However, there are still some patients who do not have a good effect after using tropisetron. More and more studies indicated that these individual differences might be closely related to genetic polymorphisms. In order to provide ideas for clinical individualized medication under the guidance of gene polymorphisms, this article reviewed the influence of CYP2D6 gene polymorphisms on the effect of tropisetron in preventing CINV.
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Aim/Background: Chemotherapy-induced nausea and vomiting (CINV) is one of the most distressing side effects of highly emetogenic chemotherapy regimens. There have been continuous efforts in the direction to control CINV by many investigators. Materials and Methods: Randomly selected patients were those receiving highly emetogenic chemotherapy regimen grouped into yoga and standard antiemetic therapy (n = 50) just before receiving chemotherapy and continued for the following days and other group (n = 50) received only the standard antiemetic agent. Both the groups were assessed, followed for acute and delayed onset of chemotherapy-induced and anticipatory nausea and vomiting using radiation therapy oncology group grading for the same. We also assessed the quality of life of the patient using the Functional Assessment of Cancer Therapy-General questionnaire. Results: The median age group of the patients was 51 years with male:female ratio 2:1, The Eastern Cooperative Oncology Group (ECOG) performance status was 0/1 in 38% of the selected population, while ECOG 2 in 62% of the patients. In yoga arm, insignificant reduction in chemotherapy-induced nausea (90% vs. 78%, P = 0.35) and but significant reduction in vomiting (42% vs. 22%, P =0.01) was observed as compared to the standard antiemetics only arm. There was a significant reduction in Grade 2 and 3 nausea (84% vs. 38% P < 0.01) and vomiting (14% vs. 0% P < 0.01). Quality of life is also significantly improved in the yoga arm, especially in the ECOG 2 performance status. Conclusions: This study concludes that yoga along with standard antiemetic medication should be a part of the management plan for the cancer patients receiving highly emetogenic chemotherapy
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Background: Despite advances in symptom management, chemotherapy-induced nausea and vomiting (CINV) remains one of the most dreadful consequences of cancer therapy.Methods: The study was carried out at Medical Oncology Department, Vydehi Institute of Medical Sciences and Research Centre, Bangalore. Hundred and forty-four cancer patients of either sex, aged 18-65 years with adequate blood counts requiring moderately emetogenic chemotherapy (MEC) as per Hesketh classification were included. The patients were prospectively divided into two groups before the initial cycle of chemotherapy. Patients in Group A (n=71) received ondansetron, and dexamethasone along with aprepitant capsules, Whereas, Group B (n=73) received palonosetron, and dexamethasone along with placebo capsules, 30 minutes before chemotherapy. Thereafter the patients were administered with the drugs and observed for nausea and vomiting. The efficiency of both regimens was assessed by adopting validated functional living index emesis (FLIE) questionnaire. Analysis of the data was done using the SPSS 21.0 software.Results: The mean age of the patients was 40.5 years and the male to female ratio was 1:2.4. In all the patients, no changes were detected in the ECG readings after MEC. The nausea and vomiting score were comparable in both groups. No significant difference (p>0.05) was noticed between group A and group B in both mm and in FLIE points. No serious adverse events were found relating to antiemetic treatment.Conclusions: Palonosetron in combination with corticosteroids was non inferior to ondansetron in combination with aprepitant and corticosteroids in controlling acute and delayed stages of CINV in patients requiring MEC. Thus, it can be recommended as first-line therapy for patients treated with MEC.
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Background: Chemotherapy induced nausea and vomiting is the most distressing side effect of cancer chemotherapy. It can seriously impact patient抯 quality of life, influence the adherence to chemotherapy and progression free survival causing a delay or refusal of potentially life-saving therapy. The objective of this study was to compare the efficacy of palonosetron with ramosetron in achieving complete response to the chemotherapy.Methods: This was a prospective randomized open-label study conducted on 130 patients admitted in Medical Oncology ward of a Tertiary Care Hospitals, Bangalore, India. Patients were randomized to receive either palonosetron 0.25 mg or ramosetron 0.3 mg I.V. along with aprepitant and dexamethasone 30 minutes prior to chemotherapy and were followed up for a period of 5 days post chemotherapy. The observations such as number and severity of vomiting and nausea, the outcome was assessed at the end of 5 days. Pearson抯 Chi-square test was used to demonstrate the difference between both the study groups with respect to various categorical data.Results: The complete response rate in delayed phase was more significant in patients who received palonosetron than patients who received ramosetron (72.3% vs 50.8%). Total control was achieved in 38.5% patients with palonosetron as compared to 15.4% patients with ramosetron.Conclusions: Palonosetron is more efficacious than ramosetron in controlling chemotherapy induced nausea and vomiting especially in delayed phase of emesis.
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Background: Chemotherapy induced Nausea and Vomiting (CINV) is one the most common adverse effects associated with chemotherapeutic management of carcinoma breast. Preventing CINV becomes a vital part in treatment of these cancer patients for better compliance. The conventional regimen of newer 5-HT3 receptor antagonist and dexamethasone along with newer agents - Aprepitant, a NK-1 receptor antagonist and a recently approved atypical antipsychotic, Olanzapine have shown better control of CINV. These newer agents are effective but also very expensive.Methods: The study included carcinoma breast patients scheduled for chemotherapy (n = 55 in each group) who either received aprepitant or olanzapine or a combination of both as the anti-emetic regimen. Considering Cost-Effectiveness Analysis (CEA), the cost included was the cost of anti-emetic agents (sponsor’s perspective) and outcome measured as control of nausea and vomiting - as Complete Protection (CP), Complete Response to Best (CRB) and Incomplete Response (IR) for acute (0-24 hours) and delayed (24-120 hours) phases. The cost effectiveness(CE) ratio for emesis and CINV free days were calculated.Results: CP was seen better during the acute period than the delayed period. With Aprepitant, delayed CRB and IR was seen with 13 (23.6%) and 10 (18.2%) subjects. 16 (29.1%) showed IR with Olanzapine during the delayed period.The average number of Emesis and CINV free days were 4.65, 4.51, 4.89 and 3.38, 3.96, 4.15 for the three groups respectively. The cost required to achieve 1 emesis and 1 CINV free day per subject in the 3 groups was INR 351.19, INR 27.20, INR 339.54 and INR 483.36, INR 30.94, INR 400.60 respectively.Conclusions: The newer anti-emetic even though being expensive at cost, pharmacoeconomically provide better outcomes and seem to have better control rates than the conventional regimen.
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In spite of the serious effects on the patient's quality of life, the prevention and treatment of chemotherapy-induced nausea and vomiting (CINV) remains a trouble problem. With the development of new agents, the acute and delayed CINV have been significantly improved in response rate, however the controlling of nausea and breakthrough CINV are undesirable. Recently, olanzapine has been demonstrated effectively in the prevention and treatment of CINV, especially in nausea, that can improve the quality life of patients as well. The paper sketches the mechanism of CINV and mainly summarizes the progress in prevention and treatment of olanzapine in CINV.
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Objective To evaluate the effect of aromatherapy on chemotherapy-induced nausea and vomiting among lung cancer. Methods A total of 112 patient with lung cancer from Tianjin Cancer Hospital were selected and divided into control group(54 patients)and intervention group(58 patients)by random number table.The control group was given routine health care,while the intervention group was given aromatherapy and routine health care. Chinese Version of Gastroenteric Nausea and Vomiting Grading Criteria was adopted to assess chemotherapy-induced nausea and vomiting among before chemotherapy, 48 h and 5 to 7 days after chemotherapy. Functional Living Index-Emesis was used to measure quality of life among the first day, the sixth day and the eleventh day after chemotherapy. Results The study showed that there were statistical differences between two groups for acute nausea in the first(Z=-3.000, P=0.003) and third cycles (Z=-2.547, P=0.011), while there were no statistical differences in second(Z=-0.715, P=0.474) and fourth cycles (Z=-1.576, P=0.117). And for acute vomiting,all cycles had statistical significance(Z=-2.031,-2.291,-3.499,P=0.042,0.022,0.001)except the first cycle(Z=-2.830,P=0.777).There were differences among four cycles about delayed nausea and vomiting(Z=-3.475--2.144, P=0.001-0.032). It had statistical significance between control group and intervention group for quality of life(t=0.317-3.760,P=0.000-0.038). Conclusions Aromatherapy can obviously reduce extent of chemotherapy-induced nausea and vomiting, improve quality of life, so it is worth using widely in clinic.
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<p><b>OBJECTIVE</b>To observe the effectiveness and safety of electrothermal acupuncture in the prevention and treatment of chemotherapy-induced nausea and vomiting (CINV) in the cancerous patients of phlegm-stasis interaction in cisplatin-containing chemotherapy.</p><p><b>METHODS</b>Sixty cases of phlegm-stasis interaction in cisplatin-containing chemotherapy were randomized into a trial group and a control group, 30 cases in each one. In the control group, the intravenous drip of granisetron hydrochloride injection was adopted, 3 mg before and after cisplatin-containing chemotherapy 30 min, continuously for 3 days. 43 to 45℃ electrothermal acupuncture at zusanli(ST 36) for 30 min was used on the basis of the treatment as the control group in the trial group,once a day for 3 days. CINV, anti-nausea effects, Karnofsky score, the syndrome score of phlegm-stasis interaction, and relevant indices of safety were observed on the 1st and 7th days of cisplatin-containing chemotherapy separately.</p><p><b>RESULTS</b>1.Regarding CINV and anti-nausea effect, CINV did not occur before chemotherapy in the patients of the two groups. On the 1st and 7th days of chemotherapy, CINV in the trial group were milder than those in the control group (both<0.05).The anti-nausea effects in the trail group were better than those of the control group.2.Regarding Karnofsky score and the syndrome score of phlegm-stasis interaction, the improvements on the 7th days of chemotherapy in the trial group were better than those in the control group, indicating the significant differences (both<0.05). 3.Regarding the safety indies, there was no adverse reaction during the treatment in the two groups.</p><p><b>CONCLUSIONS</b>The electrothermal acupuncture effectively relieves CINV, and improves self-care dbility and the symptoms of phlegm-stasis interaction.</p>
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OBJECTIVE:To evaluate the effectiveness and safety of rolapitant combined with 5-HT3 receptor antagonist and dexamethasone for the prevention of chemotherapy-induced nausea and vomiting systematically,and to provide evidence-based reference in clinic.METHODS:Retrieved from CJFD,VIP,Wanfang Database,PubMed,EMBase and Cochrane Library,randomized controlled trials (RCTs) about rolapitant+5-HT3 receptor antagonist+ dexamethasone (trial group) vs.placebo combined with 5-HT3 receptor antagonist+dexamethasone (control group) for the prevention of chemotherapy-induced nausea and vomiting.Meta-analysis was performed by using Rev Man 5.3 statistical software after data extraction and quality evaluation with Cochrane system evaluator manual 5.1.0.RESULTS:A total of 3 literatures were included,involving 4 RCTs and 2 583 patients.The results of Meta-analysis were as follows:complete remission rate [acute stage:RR=1.10,95％ CI (1.02,1.19),P=0.01;delay stage:RR=1.18,95％ CI (1.11,1.25),P＜0.001;overall stage:RR=1.19,95 ％ CI (1.12,1.26),P＜0.001] and the proportion of patients with ftmctional indexes of vomiting living ＞ 108 [RR =1.10,95 ％ CI (1.04,1.16),P ＜ 0.001] in trial group were significantly higher than control group,with statistical significance.There was no statistical significance in the incidence of ADR between 2 groups[RR=1.10,95 ％ CI (0.82,1.47),P=0.52].CONCLUSIONS:Rolapitant combined with 5-HT3 receptor antagonist and dexamethasone can effectively prevent and relieve chemotherapy-induced nausea and vomiting,and improve the quality of life with good safety.
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Neurokinin I receptor antagonist (NK1RA) fosaprepitant is a new antiemetic drug. Fosaprepitant dimeglumine was ap-proved by FDA in January 2008, while it is still in the approval stage in China. Fosaprepitant, as a prodrug of aprepitant, is rapidly converted to aprepitant after intravenous administration in vivo. The indication of fosaprepitant is the prevention of chemotherapy in-duced nausea and vomiting ( CINV) , especially the delayed CINV. Fosaprepitant as a unique intravenous preparation overcomes the drawbacks of aprepitant with oral administration only. Its bioavailability is not affected by the vomiting of patients. It is also suitable for patients with oral mucositis, who are unfavorable for oral medication. The action mechanisms, pharmacokinetics, and clinical trials of fosaprepitant were reviewed in the paper.
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Objective To observe the effect of Jianpi Buxue Decoction on the protein expression of neurokinin 1 receptor (NK1R) and CD34 in C57BL/6 mice of lung cancer after chemotherapy, and to explore the improvement of chemotherapy-induced nausea and vomiting and myelosuppression treated with Jianpi Buxue Decoction. Methods Forty C57BL/6 mice were transplanted with Lewis lung cancer cells in the armpit of left anterior limb after being fed for 7 days, and then were randomly divided into lung cancer group, model group, and high-, middle- and low-dose Chinese medicine groups. Model group and Chinese medicine groups were injected intraperitoneally with cyclophosphamide (80 mg/kg) for one day. Lung cancer group and model group were given normal saline. Chinese medicine groups were administered with high-, middle- and low-dose of Jianpi Buxue Decoction (25, 12.6, 6.25 g/kg respectively) for 14 days. After the modeling, all of the mice were sacrificed, and then the brains and spleens were sampled. Western blotting method was used to detect the protein expression of NK1R and CD34. Results Compared with lung cancer group, the protein expression of cerebral NK1R and splenic CD34 in the model group was increased significantly ( P<0.01) . Compared with the model group, the protein expression of NK1R in mice brain tissues of high-, middle- and low- dose Jianpi Buxue Decoction groups was decreased significantly (P<0.01) , while the protein expression of CD34 in spleen tissues of middle-and low-dose Jiangpi Buxue Decoction groups was increased obviously ( P<0.05) . Conclusion Jianpi Buxue Decoction has an effect on down-regulating the protein expression of NK1R in brain tissues and on up-regulating the protein expression of CD34 in spleen tissues of C57BL/6 mice with lung cancer after chemotherapy, indicating that Jianpi Buxue Decoction probably can relieve chemotherapy-induced nausea and vomiting, and can improve the myelosuppression after chemotherapy.
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Objective To observe the efficacy and side effect of olanzapine combined with tropisetron, dexamethasone for the pre-vention of highly emetogenic chemotherapy-induced nausea and vomiting ( CINV) . Methods A total of 78 patients with highly emetogen-ic single day chemotherapy were randomly divided into two groups:trial group ( olanzapine combined with tropisetron, dexamethasone n=40) and control group (Tropisetron Combined with Dexamethasone n=38). The control of acute CINV, delayed CINV and adverse reac-tions were observed. Results The control rates of acute vomiting in trial group and control group were 87. 5% vs 81. 6%, 65. 0% vs 57. 9% in acute nausea, 75. 0% vs 52. 6% in delayed vomiting, 32. 5% vs 13. 2% in delayed nausea. The trial group was better than the control group in delayed vomiting and delayed nausea which there was difference between them (P 0. 05). Conclusion Olanzapine combined with tropisetron, dexa-methasone for the prevention was significantly better than tropisetron combined with dexamethasone in the control of delayed CINV in pa-tients received highly emetogenic chemotherapy.
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OBJECTIVES: Chemotherapy induced nausea and vomiting is most distressing adversed effects in gynecologic cancer patients receiving chemotherapy. we compared effectiveness of ondansetron and ramosetron and aprepitant for optimal antiemetic treatment in gynecologic cancer patient receiving chemotherapy. METHODS: The study was performed retrospective on 189 patients who was diagnosed initially the gynecological cancer during chemotherapy at Kosin university hospital between January 2008 and December 2010. The efficacy of controlling acute/delayed nausea and vomiting were analyzed by counting numbers of nausea and vomiting reported in medical records of 189 patient receiving cisplatin-based chemotherapy. Statistical analysis was performed using the ANOVA and Fisher's exact chi-square test. RESULTS: The efficacy of controlling nausea with an ondansetron regimen and a ramosetron regimen and an aprepitant regimen was 85.29%, 78.26%, 80% in acute periods (P-value = 0.037) and 88.23%, 98.26%, 87.5% in delayed periods (P-value = 0.000), respectively. The efficacy of controlling vomiting with an ondansetron regimen and a ramosetron regimen and an aprepitant regimen and an ondansetron regimen was 82.35%, 97.3%, 90% in acute periods (P-value=0.002) and 82.35%, 100%, 95% in delayed periods (P-value = 0.000), respectively. The common adverse effects in each groups were not significantly. CONCLUSIONS: Appropriate to each patient's symptoms, the choice of drugs will be needed since each of the drugs have different effects on vomiting. Even though the each antiemetic drug has good efficacy, the effect of the drug is not complete. Therefore the use of additional drugs are also needed.
Subject(s)
Humans , Antiemetics , Drug Therapy , Medical Records , Nausea , Ondansetron , Retrospective Studies , VomitingABSTRACT
PURPOSE: Combination therapy with aprepitant, serotonin receptor antagonist, and steroids improves the complete response rate of both acute and delayed chemotherapy-induced nausea and vomiting (CINV). However, it is not known whether ramosetron is suitable for administration in combination with aprepitant. Therefore, we conducted a multicenter, open-label, prospective, phase II study in order to assess the efficacy and tolerability of combination therapy with ramosetron, aprepitant, and dexamethasone (RAD) for prevention of cisplatin-based CINV in chemotherapy-naive patients with solid cancers. MATERIALS AND METHODS: Forty-one patients with various solid cancers (31 male and 10 female; median age, 59 years) who received treatment with highly emetogenic chemotherapy (median cisplatin dose, 70 mg/m2; range 50 to 75 mg/m2) were enrolled in this study. Oral aprepitant (125 mg on day 1; 80 mg on days 2 and 3), intravenous ramosetron (0.6 mg on day 1), and oral dexamethasone (12 mg on day 1; 8 mg on days 2-4) were administered for prevention of CINV. RESULTS: The complete response (no emesisand retching and no rescue medication) rate was 94.9% in the acute period (24 hours post-chemotherapy), 92.3% in the delayed period (24-120 hours post-chemotherapy), and 92.3% in the overall period (0-120 hours). The absolute complete response (complete response plus no nausea) rate was 74.4% in the acute period, 51.3% in the delayed period, and 46.2% in the overall period. There were no grade 3 or 4 toxicities related to these antiemetic combinations. CONCLUSION: RAD regimen is a safe and effective antiemetic treatment for prevention of CINV in patients receiving highly emetogenic chemotherapy.
Subject(s)
Humans , Male , Benzimidazoles , Cisplatin , Dexamethasone , Morpholines , Nausea , Prospective Studies , Serotonin , Steroids , VomitingABSTRACT
<b>Purpose</b>: Olanzapine has antiemetic activity for chemotherapy-induced nausea and vomiting (CINV). The purpose of this retrospective study is to evaluate the efficacy of olanzapine for prevention of CINV in patients with severe nausea resistant to standard antiemetic regimen for highly emetogenic chemotherapy (HEC). <b>Methods</b>: Olanzapine was administered in twenty gynecological cancer patients receiving HEC. They had grade 3 nausea (CTCAE ver.4.0) for the acute (24 hours postchemotherapy) and/or delayed (24-120 hours postchemotherapy) period despite the combined use of 5-HT3 receptor antagonist, NK-1 receptor antagonist, and dexamethasone. Oral olanzapine (5 mg/day) was administered on day -1 prior to chemotherapy and continued for 7 days in combination with standard antiemetic regimen. The nausea control rate (grade 0-1) with olanzapine were evaluated. <b>Results</b>: The nausea control rate improved from 30% to 95% for the acute period, 0% to 95% for the delayed period, and 0% to 90% for the overall period. In each period, the nausea control rate improved significantly (<i>p</i>≤0.001). Grade 0-1 sleepiness was observed but there were no grade 3 or 4 toxicities. Conclusion: In this study, olanzapine combined with the standard antiemetic regimen had good antiemetic activity at both acute and delayed period in most of chemotherapy-naive patients receiving HEC. The efficacy of olanzapine suggested additional improvement in the control of severe CINV resistant to standard antiemetic regimen for HEC.
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Chemotherapy is the first line treatment in management of many cancers, both for cure and palliation; hence it’s crucial to minimize the unpleasant side effects of chemotherapy to increase tolerability to chemotherapy. Most of the conventional anti cancer drugs are emetogenic. Patients receiving chemotherapy experience different degrees of nausea and vomiting depending on the emetogenic potential of the anti cancer drugs given and the patient characteristics. With a better understanding of the pathophysiology, distinct phases of chemotherapy-induced nausea and vomiting (CINV) i.e., acute emesis, delayed emesis and anticipatory emesis have been identified. Identification of various mediators has led to the development of different drugs acting through different mechanisms which are useful in the prevention and treatment of CINV. Serotonin receptor three (5-HT3) antagonists, corticosteroids and neurokinin type one receptor (NK-1) antagonists are of proven usefulness and have wide therapeutic indexes in the prevention of CINV. Other drugs like dopamine receptor antagonists & benzodiazepines are not routinely used because of their narrow therapeutic index. Practice guidelines for prevention of CINV will not only improve patient’s tolerability to chemotherapy & wellbeing, but also decrease hospital stay and overall cost of treatment of the patient.
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Chemotherapy is the first line treatment in management of many cancers, both for cure and palliation; hence it’s crucial to minimize the unpleasant side effects of chemotherapy to increase tolerability to chemotherapy. Most of the conventional anti cancer drugs are emetogenic. Patients receiving chemotherapy experience different degrees of nausea and vomiting depending on the emetogenic potential of the anti cancer drugs given and the patient characteristics. With a better understanding of the pathophysiology, distinct phases of chemotherapy-induced nausea and vomiting (CINV) i.e., acute emesis, delayed emesis and anticipatory emesis have been identified. Identification of various mediators has led to the development of different drugs acting through different mechanisms which are useful in the prevention and treatment of CINV. Serotonin receptor three (5-HT3) antagonists, corticosteroids and neurokinin type one receptor (NK-1) antagonists are of proven usefulness and have wide therapeutic indexes in the prevention of CINV. Other drugs like dopamine receptor antagonists & benzodiazepines are not routinely used because of their narrow therapeutic index. Practice guidelines for prevention of CINV will not only improve patient’s tolerability to chemotherapy & wellbeing, but also decrease hospital stay and overall cost of treatment of the patient.