Outcomes of antiemetic prophylaxis in children undergoing bone marrow transplantation

A prospective survey of the control of acute and delayed antineoplastic and radiation-induced nausea and vomiting was undertaken in children undergoing bone marrow transplantation (BMT) at The Hospital for Sick Children. Prior administration of antineoplastic agents or irradiation, presence of anticipatory nausea or vomiting prior to starting the conditioning regimen, antiemetic use within 24 h of conditioning, the prescribed antineoplastic and/or radiation ablative regimen, and prescribed antiemetic regimens were recorded. Emetic episodes, dietary intake, administration of conditioning agents and antiemetics, and adverse effects were monitored on each day of the conditioning regimen and for 96 h thereafter. Children older than 3 years of age assessed their nausea on each study day. Twenty-five children were followed for 258 patient days. Children did not vomit or retch on 73% and 43% of patient days, in the acute and delayed phases, respectively. Nausea data were evaluable for 21 children on 200 patient days. Nausea was absent on 55% and 26% of patient days in the acute and delayed phases, respectively. Five children never had an emetic episode during the entire study period. One child was completely free from nausea and vomiting throughout the study period. Antineoplastic and radiation-induced nausea and vomiting can be successfully prevented in the majority of children undergoing BMT. However, effective treatment strategies must be developed in the event of antiemetic failure and for effective prophylaxis in children who cannot tolerate dexamethasone.

Chemotherapy for advanced colorectal cancer: ‘Tomudex™’

Palliative chemotherapy in advanced colorectal cancer prolongs survival and maintains quality of life, compared with best supportive care alone. For several decades, only chemotherapy regimens based on 5-fluorouracil, with or without leucovorin (LV), were available, and the recent availability of ‘Tomudex’ (raltitrexed) has provided an additional therapeutic option. The efficacy of ‘Tomudex’ (response rates, survival and palliative benefits) is similar to that of 5-fluorouracil-based regimens. A large clinical trial (495 patients with advanced colorectal cancer) showed that the superior tolerability profile of ‘Tomudex’ compared with 5-fluorouracil/LV, especially during the first cycle of treatment, led to better maintained quality of life (Zalcberg, 1997). Furthermore, the administration of ‘Tomudex’ is simpler for patients and nurses, and patients have identified the side-effect and administration profiles of ‘Tomudex’ as less upsetting than standard chemotherapy regimens. Where chemotherapy regimens provide equivalent response rates and survival, treatment should be guided by additional criteria that are relevant to the ways in which chemotherapy affects patients’ day-to-day lives. In this regard, ‘Tomudex’ displays a number of important advantages over standard 5-fluorouracil-based chemotherapy. The discovery of ‘Tomudex’ is a significant step forward in the development of chemotherapy for advanced colorectal cancer.