Comparative study of tropisetron with the addition of dexamethasone or alprazolam in breast cancer patients receiving adjuvant chemotherapy with CEF (cyclophosphamide, epirubicin and 5-fluorouracil).

We studied tropisetron (T) in patients with breast cancer receiving standard adjuvant chemotherapy with CEF (cyclophosphamide, epirubicin and 5-fluorouracil) over 3 consecutive cycles; T was administered alone or in combination with dexamethasone (D) or alprazolam (A). 50 women entered and during the 1st cycle patients received T i.v. before chemotherapy and the same dose orally on each of the following 3 days. In the 2nd cycle, T was administered together with D and during the 3rd cycle, T was combined with A and continued with T over the ensuing 3 days post-chemotherapy. Stress was present in 23 women and was evaluated for its impact on antiemetic response. Differences in the emetogenic response were found for nausea and vomiting mainly with the addition of A. The combination of T+A was superior to T and T+D in acute emesis (P<0.001). Concerning delayed emesis, differences were detected with both T+D and T+A (being equally effective) and superior to T alone (P<0.001). The emetogenic potential was decreased by the addition of A in comparison to T alone (P=0.001). Patients without stress had no difference, while patients with stress had a significantly better antiemetic result with the addition of D or A to T. In conclusion, T provides a satisfactory result in controlling nausea and emesis caused by moderately emetogenic CT regimens. Addition of D or A improves the antiemetic effect, and A provides better coverage in women with stress, a finding worth exploration in larger confirmatory studies.

Ondansentron and dexamethasone treatment with different dosing schedules (24 versus 32 mg) in patients with non-small-cell lung cancer under cisplatin-based chemotherapy: a randomized study.

The purpose of this study was to determine whether ondansentron given to patients with non-small-cell lung cancer (NSCLC) undergoing cisplatin-based chemotherapy, has better antiemetic activity administered every 6 or 8 h in controlling cisplatin-induced emesis. All patients had previously received 3 cycles of cisplatin-based chemotherapy at a dose of 100 mg/m(2). Ondansentron was given according to two schedules in group A (50 patients) at a dose of 8 mg in 100 ml normal saline over 10 min i.v. infusion, together with dexamethasone 8 mg before the infusion of cisplatin, continued with both drugs at the same dose and administration after 8 and 16 h; in group B (50 patients) both drugs were administered before the infusion of cisplatin, continued after 6, 12 and 18 h. During the next 3 days, patients continued with tablets of dexamethasone 4 mg and ondansentron 8 mg, group A every 8 h, and group B every 6 h. The only difference in terms of antiemetic response that was noticed between the two groups was the number of patients experiencing nausea which was found increased in group A (n = 32) in comparison to group B (n = 25) (p < 0.022). No difference was noticed in the number of vomiting episodes and retches or emesis control, during the 3-day evaluation period after cisplatin infusion or in side effects. In conclusion, the total dose of 24 mg ondansentron during the acute phase of emesis is as effective as the total dose of 32 mg.

Moraxella catarrhalis endocarditis: case report and review of the literature.

A case of bacterial endocarditis caused by Moraxella catarrhalis in an apparently immunocompetent Greek male is presented, which was diagnosed after a 2-month history of low-grade fever of unknown origin. The agent seems to be a rare pathogen, but due to the high mortality rate, it should always be considered in the differential diagnosis of relevant cases. Beta-lactamase production by many strains complicates the choice of antibiotic.