Control of cisplatin-induced emesis with intravenous ondansetron plus intravenous dexamethasone: a crossover study of triple 8-mg dose of ondansetron

Prevalence and predictors of long-delayed (> 120 h) chemotherapy-induced nausea and vomiting (CINV)-a systematic review and individual patient data meta-analysis

INTRODUCTION

Although there have been reports of chemotherapy-induced nausea and vomiting (CINV) beyond 120 h, its overall prevalence has not been systematically examined. The aim of this review and meta-analysis was to report on the prevalence of this long-delayed CINV.

METHODS

This review was registered on PROSPERO (CRD42022346963). PubMed (Medline), Embase, and Cochrane Central were searched from inception until August 2022. Articles were included if they reported on CINV > 120 h after initiation of the chemotherapy regimen and patients received a single-agent highly emetogenic (HEC) or moderately emetogenic (MEC) antineoplastic agent for 1 day alone or in combination with low/minimal emetogenic chemotherapy. For all eligible articles, individual study authors were contacted and requested to provide individual patient-level data of demographics, emetogenicity of chemotherapy regimens, and daily incidence of nausea and vomiting. Forward stepwise logistic regression identified predictors for the incident day's CINV based on prior day's CINV episodes, controlling for patient demographics, and stratified by regimen emetogenicity.

RESULTS

A total of 2048 patients from 2 studies were included in this individual patient data meta-analysis: 1333 patients (65%) received HEC and 715 (35%) received MEC. Among those receiving HEC, 325 (24%) experienced acute, 652 (49%) delayed, and 393 (31%) long-delayed nausea; 107 (8%) experienced acute, 179 (14%) delayed, and 79 (6%) long-delayed vomiting. Among those receiving MEC, 48 (7%) experienced acute, 272 (38%) delayed, and 167 (24%) long-delayed nausea; 12 (2%) experienced acute, 97 (14%) delayed, and 42 (6%) long-delayed vomiting. Nausea in the long-delayed phase was as severe as in the delayed phase. Patients experiencing nausea and vomiting on days 4 and 5 were at significant risk of experiencing long-delayed CINV.

CONCLUSION

While not as prevalent as delayed nausea and vomiting, long-delayed CINV affects a significant proportion of patients and severity is similar. Patients with delayed CINV, specifically on days 4-5, are at risk of experiencing long-delayed CINV.

Corticosteroid rotation to alleviate dexamethasone-induced hiccup: a case series at a single institution

Dexamethasone, one of the key medications for the prevention of chemotherapy-induced nausea and vomiting (CINV), may cause hiccups as an adverse effect. In this case series, we present five patients who developed hiccups after receiving dexamethasone for CINV. We successfully switched dexamethasone to an equipotent dosage of either methylprednisolone or prednisolone, which resolved the hiccups while maintaining adequate control of CINV. This was achieved without changing the rest of the antiemetic regimen, chemotherapy doses, or the use of other medications such as baclofen, haloperidol, and metoclopramide for hiccups. Further studies on switching dexamethasone to alternative corticosteroids in patients developing hiccups after administration of dexamethasone are warranted.

Incidence and temporal pattern of anorexia, diarrhea, weight loss, and leukopenia in patients with cervical cancer treated with concurrent radiation therapy and weekly cisplatin: comparison with radiation therapy alone

OBJECTIVE

To investigate the temporal patterns of anorexia, diarrhea, weight loss, and leukopenia in chemoradiation therapy (CRT) for cervical cancer compared with radiation therapy (RT) alone.

METHODS

Acute toxicities in 43 patients receiving RT alone and 40 patients receiving CRT were retrospectively analyzed. Patients were treated with a combination of external beam irradiation and high-dose rate intracavitary irradiation. Cisplatin was given once a week for 5 weeks concurrently with the external beam irradiation. CRT was divided into low-dose CRT group (cisplatin, 20-30 mg/m(2), n = 16) and high-dose CRT group (cisplatin, 35-40 mg/m(2), n = 24). Toxicities were evaluated before, every week up to 7 weeks during the cycle, and 12 weeks after initial irradiation, according to the National Cancer Institute Common Toxicity Criteria version 2.

RESULTS

In the high-dose CRT group, anorexia during the first 5 weeks, leukopenia after 5 weeks, and weight loss after 3 weeks were significantly higher than those in the RT alone group. In the low-dose CRT group, anorexia between 1 and 2 weeks, leukopenia after 5 weeks, and weight loss between 3 and 4 weeks were significantly higher than those in the RT alone group. Diarrhea between 1 and 2 weeks in the high-dose CRT group (P = 0.037, P = 0.025) and between 2 and 3 weeks in the low-dose CRT group (P = 0.015, P = 0.036) was significantly lower compared with RT alone.

CONCLUSION

These data can help us understand when patients are likely to develop maximal toxicities and to manage them with optimal timing.

A Randomised Crossover Study Comparing Ramosetron plus Dexamethasone with Ramosetron Alone in the Prevention of Cisplatin-Induced Emesis

OBJECTIVE

To assess the efficacy and tolerability of a combination of ramosetron and dexamethasone compared with ramosetron alone in the prevention of cisplatin-induced emesis.

DESIGN

Prospective, randomised, single-blind, crossover study.

PATIENTS

Thirty-four chemotherapy-naive patients with stomach cancer or sar-coma scheduled to receive two consecutive courses of cisplatin-based chemo-therapy.

INTERVENTIONS

Patients were randomised to receive ramosetron (0.3mg intravenously [IV] on day 1 then 0.1mg orally [PO] once daily on days 2-6) either with or without dexamethasone (20mg IV on days 1-6). Those who completed the first chemotherapy cycle returned for a second cycle after 4 weeks and were crossed over to the alternate antiemetic treatment.

RESULTS

In the first 24 hours, complete response was achieved in 84.8% of patients receiving ramosetron plus dexamethasone and in 59.4% of patients receiving ramosetron alone (p = 0.014). Furthermore, the combination ramosetron plus dexamethasone was significantly more effective in terms of time to first episode of vomiting and patient's preference. On day 2, patients who received ramosetron plus dexamethasone had a higher complete response rate than those who received ramosetron alone (p = 0.047). Adverse events were mild with no significant differences between the two groups.

CONCLUSIONS

The combination of ramosetron plus dexamethasone was superior to ramosetron alone in preventing cisplatin-induced acute emesis. It is highly recommended that a combination of ramosetron plus dexamethasone rather than ramosetrone alone be given to patients receiving cisplatin-containing chemo-therapy.