1
|
Herrstedt J, Clark-Snow R, Ruhlmann CH, Molassiotis A, Olver I, Rapoport BL, Aapro M, Dennis K, Hesketh PJ, Navari RM, Schwartzberg L, Affronti ML, Garcia-Del-Barrio MA, Chan A, Celio L, Chow R, Fleury M, Gralla RJ, Giusti R, Jahn F, Iihara H, Maranzano E, Radhakrishnan V, Saito M, Sayegh P, Bosnjak S, Zhang L, Lee J, Ostwal V, Smit T, Zilic A, Jordan K, Scotté F. 2023 MASCC and ESMO guideline update for the prevention of chemotherapy- and radiotherapy-induced nausea and vomiting. ESMO Open 2024; 9:102195. [PMID: 38458657 PMCID: PMC10937211 DOI: 10.1016/j.esmoop.2023.102195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 11/06/2023] [Indexed: 03/10/2024] Open
Abstract
•Nausea and vomiting are considered amongst the most troublesome adverse events for patients receiving antineoplastics. •The guideline covers emetic risk classification, prevention and management of treatment-induced nausea and vomiting. •The Consensus Committee consisted of 34 multidisciplinary, health care professionals and three patient advocates. •Recommendations are based on evidence-based data (level of evidence) and the authors’ collective expert opinion (grade). •All recommendations are for the first course of antineoplastic therapy; modifications may be needed in subsequent courses.
Collapse
Affiliation(s)
- J Herrstedt
- Department of Clinical Oncology, Zealand University Hospital Roskilde and Naestved, Roskilde; Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - R Clark-Snow
- Oncology Supportive Care Consultant, Overland Park, USA
| | - C H Ruhlmann
- Department of Oncology, Odense University Hospital, Odense; Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - A Molassiotis
- College of Arts, Humanities and Education, University of Derby, Derby, UK
| | - I Olver
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia
| | - B L Rapoport
- The Medical Oncology Centre of Rosebank, Johannesburg; Department of Immunology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - M Aapro
- Genolier Cancer Center, Genolier, Switzerland
| | - K Dennis
- Division of Radiation Oncology, The Ottawa Hospital and the University of Ottawa, Ottawa, Canada
| | - P J Hesketh
- Division of Hematology Oncology, Lahey Hospital and Medical Center, Burlington
| | | | - L Schwartzberg
- William N. Pennington Cancer Institute, University of Nevada, Reno School of Medicine, Reno
| | - M L Affronti
- Department of Neurosurgery, The Preston Robert Tisch Brain Tumor Center, Duke University Medical Center, Durham; Duke University School of Nursing, Duke University, Durham, USA
| | - M A Garcia-Del-Barrio
- Pharmacy Department, Clínica Universidad de Navarra, Madrid; School of Pharmacy and Nutrition, Universidad de Navarra, Pamplona, Spain
| | - A Chan
- Department of Clinical Pharmacy Practice, School of Pharmacy & Pharmaceutical Sciences, University of California Irvine, Irvine, USA
| | - L Celio
- Independent Medical Oncologist, Milan, Italy
| | - R Chow
- Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - M Fleury
- Department of Oncology, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - R J Gralla
- Albert Einstein College of Medicine, Jacobi Medical Center, Bronx, USA
| | - R Giusti
- Medical Oncology Unit, Sant' Andrea Hospital of Rome, Rome, Italy
| | - F Jahn
- Clinic for Internal Medicine IV, Oncology - Hematology - Hemostaseology, University Hospital Halle (Saale), Halle, Germany
| | - H Iihara
- Department of Pharmacy, Gifu University Hospital, Gifu, Japan
| | | | - V Radhakrishnan
- Department of Medical Oncology, Cancer Institute (WIA), Adyar, Chennai, India
| | - M Saito
- Department of Breast Oncology, Juntendo University School of Medicine, Tokyo, Japan
| | - P Sayegh
- Department of Pharmacy, OU Health Stephenson Cancer Center, Oklahoma City, USA
| | - S Bosnjak
- Department of Supportive Oncology and Palliative Care, Institute for Oncology and Radiology of Serbia, Belgrade, Serbia
| | - L Zhang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - J Lee
- College of Nursing and Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul, Korea
| | - V Ostwal
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - T Smit
- The Medical Oncology Centre of Rosebank, Johannesburg
| | - A Zilic
- Department of Supportive Oncology and Palliative Care, Institute for Oncology and Radiology of Serbia, Belgrade, Serbia
| | - K Jordan
- Department of Hematology, Oncology and Palliative Medicine, Ernst von Bergmann Hospital, Potsdam; Department of Medicine V, Hematology, Oncology and Rheumatology, University of Heidelberg, Heidelberg, Germany
| | - F Scotté
- ∗Interdisciplinary Patient Pathway Division, Gustave Roussy, Villejuif, France.
| |
Collapse
|
2
|
Herrstedt J, Celio L, Hesketh PJ, Zhang L, Navari R, Chan A, Saito M, Chow R, Aapro M. 2023 updated MASCC/ESMO consensus recommendations: prevention of nausea and vomiting following high-emetic-risk antineoplastic agents. Support Care Cancer 2023; 32:47. [PMID: 38127246 PMCID: PMC10739516 DOI: 10.1007/s00520-023-08221-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
PURPOSE This systematic review updates the MASCC/ESMO recommendations for high-emetic-risk chemotherapy (HEC) published in 2016-2017. HEC still includes cisplatin, carmustine, dacarbazine, mechlorethamine, streptozocin, and cyclophosphamide in doses of > 1500 mg/m2 and the combination of cyclophosphamide and an anthracycline (AC) in women with breast cancer. METHODS A systematic review report following the PRISMA guidelines of the literature from January 1, 2015, until February 1, 2023, was performed. PubMed (Ovid), Scopus (Google), and the Cochrane Database of Systematic Reviews were searched. The literature search was limited to randomized controlled trials, systematic reviews, and meta-analyses. RESULTS Forty-six new references were determined to be relevant. The main topics identified were (1) steroid-sparing regimens, (2) olanzapine-containing regimens, and (3) other issues such as comparisons of antiemetics of the same drug class, intravenous NK1 receptor antagonists, and potentially new antiemetics. Five updated recommendations are presented. CONCLUSION There is no need to prescribe steroids (dexamethasone) beyond day 1 after AC HEC, whereas a 4-day regimen is recommended in non-AC HEC. Olanzapine is now recommended as a fixed part of a four-drug prophylactic antiemetic regimen in both non-AC and AC HEC. No major differences between 5-HT3 receptor antagonists or between NK1 receptor antagonists were identified. No new antiemetic agents qualified for inclusion in the updated recommendations.
Collapse
Affiliation(s)
- Jørn Herrstedt
- Department of Clinical Oncology, Zealand University Hospital, Sygehusvej 10, DK-4000, Roskilde, Denmark.
- Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
| | | | - P J Hesketh
- Division of Hematology Oncology, Lahey Hospital and Medical Center, Burlington, MA, USA
| | - L Zhang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - R Navari
- World Health Organization, Birmingham, Alabama, USA
| | - A Chan
- Department of Clinical Pharmacy Practice, School of Pharmacy & Pharmaceutical Sciences, University of California Irvine, Irvine, CA, USA
| | - M Saito
- Department of Breast Oncology, Juntendo University School of Medicine, Tokyo, Japan
| | - R Chow
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - M Aapro
- Genolier Cancer Center, Genolier, Switzerland
| |
Collapse
|
3
|
Roila F, Molassiotis A, Herrstedt J, Aapro M, Gralla RJ, Bruera E, Clark-Snow RA, Dupuis LL, Einhorn LH, Feyer P, Hesketh PJ, Jordan K, Olver I, Rapoport BL, Roscoe J, Ruhlmann CH, Walsh D, Warr D, van der Wetering M. 2016 MASCC and ESMO guideline update for the prevention of chemotherapy- and radiotherapy-induced nausea and vomiting and of nausea and vomiting in advanced cancer patients. Ann Oncol 2016; 27:v119-v133. [PMID: 27664248 DOI: 10.1093/annonc/mdw270] [Citation(s) in RCA: 356] [Impact Index Per Article: 44.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
- F Roila
- Medical Oncology, Santa Maria Hospital, Terni, Italy
| | - A Molassiotis
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China SAR
| | - J Herrstedt
- Department of Oncology, Odense University Hospital, Odense, Denmark
| | - M Aapro
- Clinique de Genolier, Multidisciplinary Oncology Institute, Genolier, Switzerland
| | - R J Gralla
- Albert Einstein College of Medicine, Jacobi Medical Center, New York
| | - E Bruera
- Department of Palliative, Rehabilitation and Integrative Medicine, UT MD Anderson Cancer Center, Houston
| | - R A Clark-Snow
- The University of Kansas Cancer Center, Westwood, Kansas, USA
| | - L L Dupuis
- Department of Pharmacy and Research Institute, The Hospital for Sick Children, Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada
| | - L H Einhorn
- Division of Hematology-Oncology, Simon Cancer Center, Indiana University, Indianapolis, USA
| | - P Feyer
- Department of Radiation Oncology, Vivantes Clinics, Neukoelln, Berlin, Germany
| | - P J Hesketh
- Lahey Health Cancer Institute, Burlington, USA
| | - K Jordan
- Department of Hematology/Oncology, Martin-Luther-University Halle-Wittemberg, Halle, Germany
| | - I Olver
- Sansom Institute for Health Research, University of South Australia, Adelaide, Australia
| | - B L Rapoport
- Medical Oncology Centre of Rosebank, Johannesburg, South Africa
| | - J Roscoe
- Department of Surgery, University of Rochester Medical Center, Rochester, USA
| | - C H Ruhlmann
- Department of Oncology, Odense University Hospital, Odense, Denmark
| | - D Walsh
- Academic Department of Palliative Medicine, Our Lady's Hospice and Care Services, Dublin, Ireland
| | - D Warr
- Cancer Clinical Research Unit, Princess Margaret Cancer Centre, Toronto, Canada
| | - M van der Wetering
- Department of Paediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, The Netherlands
| | | |
Collapse
|
4
|
Hesketh PJ, Rossi G, Rizzi G, Palmas M, Alyasova A, Bondarenko I, Lisyanskaya A, Gralla RJ. Efficacy and safety of NEPA, an oral combination of netupitant and palonosetron, for prevention of chemotherapy-induced nausea and vomiting following highly emetogenic chemotherapy: a randomized dose-ranging pivotal study. Ann Oncol 2014; 25:1340-1346. [PMID: 24608196 PMCID: PMC4071755 DOI: 10.1093/annonc/mdu110] [Citation(s) in RCA: 161] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Revised: 03/01/2014] [Accepted: 03/04/2014] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND NEPA is a novel oral fixed-dose combination of netupitant (NETU), a new highly selective neurokinin-1 (NK1) receptor antagonist (RA) and palonosetron (PALO), a pharmacologically and clinically distinct 5-hydroxytryptamine type 3 (5-HT3) RA. This study was designed to determine the appropriate clinical dose of NETU to combine with PALO for evaluation in the phase 3 NEPA program. PATIENTS AND METHODS This randomized, double-blind, parallel group study in 694 chemotherapy naïve patients undergoing cisplatin-based chemotherapy for solid tumors compared three different oral doses of NETU (100, 200, and 300 mg) + PALO 0.50 mg with oral PALO 0.50 mg, all given on day 1. A standard 3-day aprepitant (APR) + IV ondansetron (OND) 32 mg regimen was included as an exploratory arm. All patients received oral dexamethasone on days 1-4. The primary efficacy endpoint was complete response (CR: no emesis, no rescue medication) during the overall (0-120 h) phase. RESULTS All NEPA doses showed superior overall CR rates compared with PALO (87.4%, 87.6%, and 89.6% for NEPA100, NEPA200, and NEPA300, respectively versus 76.5% PALO; P < 0.050) with the highest NEPA300 dose studied showing an incremental benefit over lower NEPA doses for all efficacy endpoints. NEPA300 was significantly more effective than PALO and numerically better than APR + OND for all secondary efficacy endpoints of no emesis, no significant nausea, and complete protection (CR plus no significant nausea) rates during the acute (0-24 h), delayed (25-120 h), and overall phases. Adverse events were comparable across groups with no dose response. The percent of patients developing electrocardiogram changes was also comparable. CONCLUSIONS Each NEPA dose provided superior prevention of chemotherapy-induced nausea and vomiting (CINV) compared with PALO following highly emetogenic chemotherapy; however, NEPA300 was the best dose studied, with an advantage over lower doses for all efficacy endpoints. The combination of NETU and PALO was well tolerated with a similar safety profile to PALO and APR + OND.
Collapse
Affiliation(s)
- P J Hesketh
- Lahey Hospital & Medical Center, Burlington, USA.
| | - G Rossi
- Corporate Clinical Development and Statistics & Data Management, Helsinn Healthcare SA, Lugano, Switzerland
| | - G Rizzi
- Corporate Clinical Development and Statistics & Data Management, Helsinn Healthcare SA, Lugano, Switzerland
| | - M Palmas
- Corporate Clinical Development and Statistics & Data Management, Helsinn Healthcare SA, Lugano, Switzerland
| | - A Alyasova
- Federal State Institution, Privolzhsky District Medical Center under the Federal Medical-Biological Agency of Russia, Nizhny Novgorod, Russia
| | - I Bondarenko
- Dnepropetrovsk Medical Academy, Dnepropetrovsk, Ukraine
| | - A Lisyanskaya
- City Clinical Oncology Dispensary, Saint Petersburg, Russia
| | - R J Gralla
- Albert Einstein College of Medicine, Bronx, USA
| |
Collapse
|
5
|
Komorowski AW, Morrow GR, Ahmed R, Cox D, Hesketh PJ. A multicenter, single-arm evaluation of palonosetron for the prevention of chemotherapy-induced nausea and vomiting (CINV) in patients who have experienced CINV during the previous cycle of low emetogenic chemotherapy (LEC). J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.e19587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
6
|
Hesketh PJ, Moiseyenko V, Rosati G, Makhson A, Levin J, Russo MW. Phase III study of single-dose casopitant in combination with ondansetron and dexamethasone for the prevention of oxaliplatin-induced nausea and vomiting. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.9019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
7
|
Roila F, Herrstedt J, Aapro M, Gralla RJ, Einhorn LH, Ballatori E, Bria E, Clark-Snow RA, Espersen BT, Feyer P, Grunberg SM, Hesketh PJ, Jordan K, Kris MG, Maranzano E, Molassiotis A, Morrow G, Olver I, Rapoport BL, Rittenberg C, Saito M, Tonato M, Warr D. Guideline update for MASCC and ESMO in the prevention of chemotherapy- and radiotherapy-induced nausea and vomiting: results of the Perugia consensus conference. Ann Oncol 2010; 21 Suppl 5:v232-43. [PMID: 20555089 DOI: 10.1093/annonc/mdq194] [Citation(s) in RCA: 454] [Impact Index Per Article: 32.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- F Roila
- Department of Medical Oncology, S. Maria University Hospital, Terni, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
8
|
Blanchard EM, Domhan S, Ma L, Schwager C, Ambika S, Martin LA, Debus J, Hesketh PJ, Hlatky L, Abdollahi A. Peripheral blood transcriptomics-based molecular predictors of breast cancer. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.e21018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
9
|
Hesketh PJ, Warr DG, Street JC, Carides AD. Differential time course of action of 5-HT 3 and NK 1 antagonists when used with highly and moderately emetogenic chemotherapy (HEC and MEC). J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.9629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
9629 Background: Cisplatin-based HEC displays a biphasic pattern of emesis with both an early and delayed period. In contrast, MEC has a monophasic pattern. The objective of this analysis was to investigate the time course of action of the 5-HT3antagonist ondansetron (OND) and the NK1 antagonist aprepitant (APR) in trials with HEC and MEC. Methods: Phase III HEC and MEC trials of APR were included. In 2 HEC studies, patients (pts) scheduled to receive cisplatin- based chemotherapy were randomized to an active-control group (OND + dexamethasone [DEX] Day 1, DEX bid Days 2–4) or an APR group (APR + OND + DEX Day 1; APR + DEX qd Days 2–3; and DEX Day 4). In a third HEC study, control pts also received OND on Days 2- 3. For the MEC study, breast cancer pts receiving anthracycline + cyclophosphamide-based chemotherapy were randomized to an active- control group (OND + DEX pre chemotherapy and OND 8 hours (h) later; OND bid Days 2–3) or an APR group (APR + OND + DEX pre chemotherapy and OND 8 h later; APR qd Days 2–3). In a post-hoc analysis, multivariate logistic regression models were used to assess the impact on emesis at different time intervals using a modified intent-to-treat approach. No multiplicity adjustment was planned, so nominal p-values are reported. Results: 1,527 pts and 856 pts were randomized and assessed for efficacy in the HEC and MEC trials respectively. For HEC, APR reduced risk of emesis beginning 15–18 h after cisplatin and extending to 48 h by 45–77% compared to control and by 45–67% compared to the OND control. For MEC, APR markedly reduced emesis from 6–9 h by 61% compared to control (p=0.0012). Conclusions: Time of onset (15 h vs. 6 h) and time course (15–48 h vs. 6–9 h) for the enhanced control of emesis with the addition of APR differs between HEC and MEC respectively. With HEC these results suggest that 5-HT3 dependent mechanisms are most important in the first 12 h after HEC with NK1-dependent mechanisms having a key role later. With MEC both 5-HT3 and NK1 mechanisms appear to be important early and the greatest impact of the NK1 antagonist occurs in the first 9 h. These results provide a rationale for maximizing NK1-antagonist exposure early on with MEC as a means to improve emesis control. [Table: see text]
Collapse
Affiliation(s)
- P. J. Hesketh
- Caritas St. Elizabeth's Medical Center, Boston, MA; Princess Margaret Hospital, Toronto, ON, Canada; Reagent, New York, NY; Merck Research Labs, West Point, PA
| | - D. G. Warr
- Caritas St. Elizabeth's Medical Center, Boston, MA; Princess Margaret Hospital, Toronto, ON, Canada; Reagent, New York, NY; Merck Research Labs, West Point, PA
| | - J. C. Street
- Caritas St. Elizabeth's Medical Center, Boston, MA; Princess Margaret Hospital, Toronto, ON, Canada; Reagent, New York, NY; Merck Research Labs, West Point, PA
| | - A. D. Carides
- Caritas St. Elizabeth's Medical Center, Boston, MA; Princess Margaret Hospital, Toronto, ON, Canada; Reagent, New York, NY; Merck Research Labs, West Point, PA
| |
Collapse
|
10
|
Gralla RJ, Raftopoulos H, Bria E, Hesketh PJ. Cisplatin in non-small cell lung cancer (NSCLC)—Reducing the most prominent toxicity, emesis: Results of a meta-analysis with 1527 patients in randomized clinical trials (RCTs) testing the addition of an NK1 antagonist. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.8064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
11
|
Hesketh PJ, Sanz-Altamira P, Bushey J, Malek K, Insalaco L, Hesketh AM. Prospective evaluation of the incidence of delayed nausea and vomiting in patients with colorectal cancer receiving oxaliplatin-based chemotherapy. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.9645] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
12
|
Davies AM, Hesketh PJ, Beckett L, Lau D, Mack PC, Lara PN, Jernigan J, LaPointe J, Gandara DR. Pharmacodynamic separation of erlotinib and docetaxel (DOC) in advanced non-small cell lung cancer (NSCLC): Overcoming hypothesized antagonism. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.7618] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
7618 Background: Epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) given concurrently with chemotherapy do not improve patient (pt) outcomes compared with chemotherapy alone in advanced NSCLC. Based on our preclinical data, we hypothesized that G1 cell cycle arrest from EGFR-TKI antagonizes the cytotoxicity of concurrent chemotherapy, and that pharmacodynamic separation (PDS) by intermittent delivery of EGFR-TKIs with chemotherapy would increase efficacy (Gumerlock, ASCO 2003, Davies, ASCO 2005). To test this concept, we conducted a phase I-II study of intermittent erlotinib combined with DOC. Methods: 37 previously treated IIIB (pleural effusion) or IV NSCLC pts received DOC 70–75 mg/m2 IV on day 1 every 21 days and erlotinib orally days 2–16 (150–200 mg). Patients without progression after 6 cycles continued erlotinib alone. Primary endpoint was response rate. Results: Pt characteristics: Age: median/range 57/35–80; Sex: 14 M; KPS ≥90=13; smoker/non-smoker/unknown 20/13/4, Median cycles: 5. Adenoca: 18. Prior chemotherapy regimens: 1 - 26; >1 - 11. In 34 evaluable pts: 1 CR, 11 PR (35% response rate), 16 stable disease. Median time to progression (TTP) was 5.6 months (95% CI: 3.7 - 7.9). MST: not reached. Treatment was generally well tolerated. Most common grade (Gr) 3/4 toxicities included: neutropenia (60%), diarrhea (16%), infection (11%), febrile neutropenia (8%). Gr 1/2 acneform rash: 88%. PK analysis showed that PDS was achieved in nadir levels of erlotinib in 4 pts tested. Correlative studies examining biomarkers for response with EGFR TKIs are ongoing. Conclusions: 1) DOC every 3 weeks plus intermittent dosing of erlotinib (2 weeks on, 1 week off) achieved PDS in limited PK sampling. 2) This combination resulted in a favorable response rate and TTP in previously treated NSCLC, with MST not yet reached. 3) Febrile neutropenia necessitated the prophylactic use of G-CSF. 4). Further clinical study of this concept is warranted, and trials are currently ongoing. [Table: see text]
Collapse
Affiliation(s)
- A. M. Davies
- UC Davis Cancer Center, Sacramento, CA; Caritas St. Elizabeth's Medical Center, Boston, MA
| | - P. J. Hesketh
- UC Davis Cancer Center, Sacramento, CA; Caritas St. Elizabeth's Medical Center, Boston, MA
| | - L. Beckett
- UC Davis Cancer Center, Sacramento, CA; Caritas St. Elizabeth's Medical Center, Boston, MA
| | - D. Lau
- UC Davis Cancer Center, Sacramento, CA; Caritas St. Elizabeth's Medical Center, Boston, MA
| | - P. C. Mack
- UC Davis Cancer Center, Sacramento, CA; Caritas St. Elizabeth's Medical Center, Boston, MA
| | - P. N. Lara
- UC Davis Cancer Center, Sacramento, CA; Caritas St. Elizabeth's Medical Center, Boston, MA
| | - J. Jernigan
- UC Davis Cancer Center, Sacramento, CA; Caritas St. Elizabeth's Medical Center, Boston, MA
| | - J. LaPointe
- UC Davis Cancer Center, Sacramento, CA; Caritas St. Elizabeth's Medical Center, Boston, MA
| | - D. R. Gandara
- UC Davis Cancer Center, Sacramento, CA; Caritas St. Elizabeth's Medical Center, Boston, MA
| |
Collapse
|
13
|
Hesketh PJ, Chansky K, Wozniak AJ, Mack P, Lara PN, Franklin WA, Hirsch FR, Crowley J, Gandara DR. Erlotinib as initial therapy in patients with advanced non-small cell lung cancer (NSCLC) and a performance status (PS) of 2: A SWOG phase II trial (S0341). J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.7536] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
7536 Background: Patients (pts) with advanced NSCLC and PS 2 have an inferior survival compared with good PS pts. Single agent and combination chemotherapy have been used with modest success with toxicity often limiting treatment. Targeted agents such as the EGFR tyrosine kinase inhibitor erlotinib (E) offer an alternative which may confer comparable benefit with better tolerance. This phase II trial of E in unselected chemotherapy-naive pts with advanced NSCLC and PS 2 was performed to obtain preliminary data regarding efficacy and EGFR biology in this pt population, and to set the stage for a subsequent randomized trial of E vs.chemotherapy, in pts selected for EGFR expression. Methods: Eligibility: stage IIIB (pleural effusion)/IV NSCLC; measurable disease; PS 2; no prior chemotherapy/biologic treatment for NSCLC. Treatment: E 150 mg orally daily. Molecular correlative studies:EGFR protein expression (IHC), gene copy (FISH), mutation analysis. Results: Pts: 82; 73 eligible; 72 fully evaluable; age (median) 74.4; M/F 47%/53%; current/former smoker 91%; stage IIIB/V 12%/88%; adenoca 54%. Treatment was well tolerated. Five pts (7%) had a grade 4 toxicity (fatigue 3 pts; dyspnea 2 pts). Most common grade 3 toxicities: fatigue 9 pts (13%); rash 7 pts (10%); diarrhea 5 pts (7%); anorexia 5 pts (7%). There was 1 possible treatment related death due to pneumonitis. One complete (1%) and 5 (7%) partial responses were noted. Stable disease was seen in 25 pts (35%) for an overall disease control rate (DCR) of 43% (31 pts). Progression free survival: 2.1 months (95% CI 1.5 –3.1); Median survival: 5.0 months (95 % CI 3.5 –7.3). One year survival: 22% (95% CI 12 –32%). Analysis of molecular correlates is ongoing. Conclusions: Single agent erlotinib is a well tolerated treatment for chemotherapy- naive patients with advanced NSCLC and PS 2 with an overall DCR of 43% and median survival of 5 months. These efficacy results are comparable to the outcome seen in SWOG trial S0027 in PS 2 pts employing sequential vinorelbine and docetaxel. We hypothesize that pt selection by an EGFR biomarker strategy will improve results with E, and that E will be superior to chemotherapy in this selected population.This trial design is under development within SWOG at present. [Table: see text]
Collapse
Affiliation(s)
- P. J. Hesketh
- Caritas St. Elizabeth's Medical Center, Boston, MA; Cancer Research and Biostatistics, Seattle, WA; Karmanos Cancer Ctr, Detroit, MI; University of California, Davis Cancer Ctr, Sacramento, CA; University of Colorado Cancer Ctr, Aurora, CO
| | - K. Chansky
- Caritas St. Elizabeth's Medical Center, Boston, MA; Cancer Research and Biostatistics, Seattle, WA; Karmanos Cancer Ctr, Detroit, MI; University of California, Davis Cancer Ctr, Sacramento, CA; University of Colorado Cancer Ctr, Aurora, CO
| | - A. J. Wozniak
- Caritas St. Elizabeth's Medical Center, Boston, MA; Cancer Research and Biostatistics, Seattle, WA; Karmanos Cancer Ctr, Detroit, MI; University of California, Davis Cancer Ctr, Sacramento, CA; University of Colorado Cancer Ctr, Aurora, CO
| | - P. Mack
- Caritas St. Elizabeth's Medical Center, Boston, MA; Cancer Research and Biostatistics, Seattle, WA; Karmanos Cancer Ctr, Detroit, MI; University of California, Davis Cancer Ctr, Sacramento, CA; University of Colorado Cancer Ctr, Aurora, CO
| | - P. N. Lara
- Caritas St. Elizabeth's Medical Center, Boston, MA; Cancer Research and Biostatistics, Seattle, WA; Karmanos Cancer Ctr, Detroit, MI; University of California, Davis Cancer Ctr, Sacramento, CA; University of Colorado Cancer Ctr, Aurora, CO
| | - W. A. Franklin
- Caritas St. Elizabeth's Medical Center, Boston, MA; Cancer Research and Biostatistics, Seattle, WA; Karmanos Cancer Ctr, Detroit, MI; University of California, Davis Cancer Ctr, Sacramento, CA; University of Colorado Cancer Ctr, Aurora, CO
| | - F. R. Hirsch
- Caritas St. Elizabeth's Medical Center, Boston, MA; Cancer Research and Biostatistics, Seattle, WA; Karmanos Cancer Ctr, Detroit, MI; University of California, Davis Cancer Ctr, Sacramento, CA; University of Colorado Cancer Ctr, Aurora, CO
| | - J. Crowley
- Caritas St. Elizabeth's Medical Center, Boston, MA; Cancer Research and Biostatistics, Seattle, WA; Karmanos Cancer Ctr, Detroit, MI; University of California, Davis Cancer Ctr, Sacramento, CA; University of Colorado Cancer Ctr, Aurora, CO
| | - D. R. Gandara
- Caritas St. Elizabeth's Medical Center, Boston, MA; Cancer Research and Biostatistics, Seattle, WA; Karmanos Cancer Ctr, Detroit, MI; University of California, Davis Cancer Ctr, Sacramento, CA; University of Colorado Cancer Ctr, Aurora, CO
| |
Collapse
|
14
|
Hesketh PJ, Younger J, Sanjay R, Trainor B, Sanz-Altamira P, Krentzin M, Hayden M, Hesketh AM. Aprepitant as salvage antiemetic therapy in breast cancer patients receiving doxorubicin and cyclophosphamide (AC). J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.8618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
8618 Background: Aprepitant (APR), a neurokinin-1 receptor antagonist, has efficacy in the prevention of nausea and vomiting (NV) in breast cancer (BC) patients (pts) receiving doxorubicin (A) and cyclophosphamide (C) (JCO 2005, 23:2822). Nevertheless, many pts continue to receive only 5-hydroxytryptamine antagonists and dexamethasone (doublet therapy) during cycle 1 of AC. APR is often used as a salvage treatment, with anecdotal reports of improved outcome. We sought to prospectively evaluate this issue in a phase II trial. Methods: Design: multicenter study funded by an unrestricted grant from Merck. Eligibility: BC pts receiving their first cycle of A (≤ 60 mg/m2) and C (≥ 500 mg/m2) on day (d) 1. Antiemetics: ondansetron 8mg IV/PO, or dolasetron 100 mg IV/PO, or granisetron 1 mg IV or 2 mg PO on d 1; and dexamethasone (dex) 8–10 mg IV/PO d 1 and 4 mg PO bid d 2–3. Pts without complete control (no emesis, nausea, or rescue antiemetics) during cycle 1 could continue to cycle 2.During cycle 2, pts again received AC and identical antiemetics (except dex only 4 mg qd d 2–3) plus APR 125 mg PO d 1 and 80 mg PO d 2–3. Data on nausea (4-point scale), emesis and rescue was collected with a pt-report diary. Primary end point: proportion of pts with complete control (CC) during the 120-hours after chemotherapy. Secondary endpoints included acute (< 24 hrs), delayed (24–120 hrs) CC and complete response (no emesis or rescue) Results: Pts: total (47), female (47), eligible (46), analyzed (42), still on study (4). Median age: 49 yrs. CC during cycle 1: 8 pts (19%). Thirty-four pts continued to cycle 2. During cycle 2, 7 pts (21%)(95% CI 9–38%) achieved CC and 13 pts (38 %) complete response (CR) for the 120-hour study period. Acute CR and delayed CR rates for cycles 1 and 2 were 32%(11 pts) vs 68% (23 pts) (p=0.01) and 12%(4 pts) vs 44% (15 pts) (p=0.02) respectively. No emesis rates were 38 vs 79 % during cycles 1 and 2 respectively(p=0.02). The proportion of pts with no nausea or severe nausea for cycles 1 and 2 were 0 vs 21% and 12 vs 3 % respectively. Conclusions: The addition of APR to standard doublet therapy improves antiemetic outcome in BC pts receiving AC who failed to achieve CC during cycle 1 with standard doublet therapy alone. Improvement is seen in the control of emesis and nausea. APR was well tolerated. [Table: see text]
Collapse
Affiliation(s)
- P. J. Hesketh
- Caritas St. Elizabeth’s Medical Center, Boston, MA; Massachusetts General Hospital, Boston, MA; Caritas Holy Family Hospital, Methuen, MA
| | - J. Younger
- Caritas St. Elizabeth’s Medical Center, Boston, MA; Massachusetts General Hospital, Boston, MA; Caritas Holy Family Hospital, Methuen, MA
| | - R. Sanjay
- Caritas St. Elizabeth’s Medical Center, Boston, MA; Massachusetts General Hospital, Boston, MA; Caritas Holy Family Hospital, Methuen, MA
| | - B. Trainor
- Caritas St. Elizabeth’s Medical Center, Boston, MA; Massachusetts General Hospital, Boston, MA; Caritas Holy Family Hospital, Methuen, MA
| | - P. Sanz-Altamira
- Caritas St. Elizabeth’s Medical Center, Boston, MA; Massachusetts General Hospital, Boston, MA; Caritas Holy Family Hospital, Methuen, MA
| | - M. Krentzin
- Caritas St. Elizabeth’s Medical Center, Boston, MA; Massachusetts General Hospital, Boston, MA; Caritas Holy Family Hospital, Methuen, MA
| | - M. Hayden
- Caritas St. Elizabeth’s Medical Center, Boston, MA; Massachusetts General Hospital, Boston, MA; Caritas Holy Family Hospital, Methuen, MA
| | - A. M. Hesketh
- Caritas St. Elizabeth’s Medical Center, Boston, MA; Massachusetts General Hospital, Boston, MA; Caritas Holy Family Hospital, Methuen, MA
| |
Collapse
|
15
|
Hesketh PJ, Grunberg SM, Herrstedt J, de Wit R, Gralla RJ, Carides AD, Taylor A, Evans JK, Horgan KJ. Combined data from two phase III trials of the NK1 antagonist aprepitant plus a 5HT 3 antagonist and a corticosteroid for prevention of chemotherapy-induced nausea and vomiting: effect of gender on treatment response. Support Care Cancer 2006; 14:354-60. [PMID: 16450086 DOI: 10.1007/s00520-005-0914-4] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2005] [Accepted: 10/26/2005] [Indexed: 12/16/2022]
Abstract
GOALS OF WORK Prevention of chemotherapy-induced nausea and vomiting (CINV) with standard antiemetics has been more difficult to achieve in female patients. Data from two phase III trials of the NK1 antagonist aprepitant were assessed for potential effect of gender on treatment response. PATIENTS AND METHODS 1,044 patients receiving cisplatin (> or = 70 mg/m2) were randomly assigned to control regimen [ondansetron (O) 32 mg i.v. and dexamethasone (D) 20 mg p.o. on day 1; D 8 mg twice daily on days 2-4] or aprepitant (A) regimen (A 125 mg p.o. plus O 32 mg and D 12 mg on day 1; A 80 mg and D 8 mg once daily on days 2-3; and D 8 mg on day 4). The primary endpoint was overall complete response (no emesis and no rescue therapy over days 1-5). Data were analyzed by a modified intent-to-treat approach. Between-treatment comparisons for each gender were made using logistic regression. MAIN RESULTS Women comprised 42 and 43% of the aprepitant and control groups, respectively. In the control group, 41% of women had overall complete response compared with 53% of men. In the aprepitant group, 66% of women had overall complete response compared with 69% of men. CONCLUSION The addition of aprepitant may negate the adverse prognostic effect of female gender on the prevention of CINV in patients receiving highly emetogenic chemotherapy.
Collapse
Affiliation(s)
- P J Hesketh
- Caritas St. Elizabeth's Medical Center, 736 Cambridge Street, Brighton, MA, 02135-2997, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
16
|
Roila F, Hesketh PJ, Herrstedt J. Prevention of chemotherapy- and radiotherapy-induced emesis: results of the 2004 Perugia International Antiemetic Consensus Conference. Ann Oncol 2006; 17:20-8. [PMID: 16314401 DOI: 10.1093/annonc/mdj078] [Citation(s) in RCA: 180] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In the late 1990s, several professional organizations convened antiemetic guideline groups and published the findings of these expert panels. Each of these documents was based on analyses of the available published trials and provided nearly similar recommendations. Nonetheless, small differences in emetic risk categories and treatment recommendations led to confusion in antiemetics selection. With the emergence of new findings and agents since the guidelines were initially published, many of the oncology professional societies have updated the antiemetic guidelines. MATERIALS AND METHODS A literature review up to March 2004 was carried out using MEDLINE with evaluation of the evidence by an expert panel composed of 23 oncology professionals in clinical medicine, medical oncology, radiation oncology, oncology nursing, statistics, pharmacy, medical policy and decision making, and pharmacology. The experts represented nine oncology professional societies and came from 11 different countries on four continents. RESULTS Recommendations on antiemetic regimens to prevent emesis induced by high, moderate, low and minimal risk chemotherapy were suggested as well as management of anticipatory emesis. Furthermore, recommendations for refractory emesis, emesis induced by high-dose chemotherapy and radiotherapy and for antiemetics in children receiving chemotherapy were elaborated. CONCLUSIONS Recommendations about antiemetic prophylaxis in patients receiving treatment with chemo- and radiotherapy have been updated by representatives of nine oncological organizations.
Collapse
Affiliation(s)
- F Roila
- Medical Oncology Division, Silvestrini Hospital, 06156S. Andrea delle Fratte, Perugia, Italy.
| | | | | |
Collapse
|
17
|
Hesketh PJ, Lilenbaum R, Chansky K, Dowlati A, Graham P, Crowley J, Gandara DR. Chemotherapy in patients ≥ 80 with advanced non-small cell lung cancer: combined results from SWOG 0027 and LUN 6. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.7147] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- P. J. Hesketh
- Caritas St Elizabeth’s Medcl Ctr, Boston, MA; Mount Sinai Cancer Ctr, Miami Beach, FL; Cancer Research and Biostatistics, Seattle, WA; Case Western Reserve Univ, Cleveland, OH; UC Davis Cancer Ctr, Sacramento, CA
| | - R. Lilenbaum
- Caritas St Elizabeth’s Medcl Ctr, Boston, MA; Mount Sinai Cancer Ctr, Miami Beach, FL; Cancer Research and Biostatistics, Seattle, WA; Case Western Reserve Univ, Cleveland, OH; UC Davis Cancer Ctr, Sacramento, CA
| | - K. Chansky
- Caritas St Elizabeth’s Medcl Ctr, Boston, MA; Mount Sinai Cancer Ctr, Miami Beach, FL; Cancer Research and Biostatistics, Seattle, WA; Case Western Reserve Univ, Cleveland, OH; UC Davis Cancer Ctr, Sacramento, CA
| | - A. Dowlati
- Caritas St Elizabeth’s Medcl Ctr, Boston, MA; Mount Sinai Cancer Ctr, Miami Beach, FL; Cancer Research and Biostatistics, Seattle, WA; Case Western Reserve Univ, Cleveland, OH; UC Davis Cancer Ctr, Sacramento, CA
| | - P. Graham
- Caritas St Elizabeth’s Medcl Ctr, Boston, MA; Mount Sinai Cancer Ctr, Miami Beach, FL; Cancer Research and Biostatistics, Seattle, WA; Case Western Reserve Univ, Cleveland, OH; UC Davis Cancer Ctr, Sacramento, CA
| | - J. Crowley
- Caritas St Elizabeth’s Medcl Ctr, Boston, MA; Mount Sinai Cancer Ctr, Miami Beach, FL; Cancer Research and Biostatistics, Seattle, WA; Case Western Reserve Univ, Cleveland, OH; UC Davis Cancer Ctr, Sacramento, CA
| | - D. R. Gandara
- Caritas St Elizabeth’s Medcl Ctr, Boston, MA; Mount Sinai Cancer Ctr, Miami Beach, FL; Cancer Research and Biostatistics, Seattle, WA; Case Western Reserve Univ, Cleveland, OH; UC Davis Cancer Ctr, Sacramento, CA
| |
Collapse
|
18
|
Hesketh PJ, Chansky K, Lau DH, Crowley J, Gandara DR. Sequential vinorelbine (V) and docetaxel (D) in advanced non-small cell lung cancer (NSCLC) patients age > 70, or with performance status (PS) 2: A SWOG phase II trial (S0027). J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.7056] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- P. J. Hesketh
- Caritas St. Elizabeth's Medical Ctr, Boston, MA; Cancer Research and Biostatistics, Seattle, WA; University of California Davis Cancer Ctr, Sacramento, CA
| | - K. Chansky
- Caritas St. Elizabeth's Medical Ctr, Boston, MA; Cancer Research and Biostatistics, Seattle, WA; University of California Davis Cancer Ctr, Sacramento, CA
| | - D. H. Lau
- Caritas St. Elizabeth's Medical Ctr, Boston, MA; Cancer Research and Biostatistics, Seattle, WA; University of California Davis Cancer Ctr, Sacramento, CA
| | - J. Crowley
- Caritas St. Elizabeth's Medical Ctr, Boston, MA; Cancer Research and Biostatistics, Seattle, WA; University of California Davis Cancer Ctr, Sacramento, CA
| | - D. R. Gandara
- Caritas St. Elizabeth's Medical Ctr, Boston, MA; Cancer Research and Biostatistics, Seattle, WA; University of California Davis Cancer Ctr, Sacramento, CA
| |
Collapse
|
19
|
Warr DG, Eisenberg P, Hesketh PJ, Gralla RJ, Muss H, Raftopolous H, Gabriel M, Rodgers A, Hustad CM, Skobieranda F. Effect of aprepitant for the prevention of nausea and vomiting after one cycle of moderately emetogenic chemotherapy: A randomized double-blind trial in 866 patients. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.8007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- D. G. Warr
- Princess Margaret Hospital, Toronto, ON, Canada; California Cancer Care, Inc., Greenbrae, CA; Caritas St. Elizabeth's Medical Center, Brighton, MA; New York Lung Cancer Alliance, New York, NY; Vermont Cancer Center, Burlington, VT; Columbia University, New York, NY; Merck & Co., Inc, Whitehouse Station, NJ; Merck & Co., Inc, West Point, PA
| | - P. Eisenberg
- Princess Margaret Hospital, Toronto, ON, Canada; California Cancer Care, Inc., Greenbrae, CA; Caritas St. Elizabeth's Medical Center, Brighton, MA; New York Lung Cancer Alliance, New York, NY; Vermont Cancer Center, Burlington, VT; Columbia University, New York, NY; Merck & Co., Inc, Whitehouse Station, NJ; Merck & Co., Inc, West Point, PA
| | - P. J. Hesketh
- Princess Margaret Hospital, Toronto, ON, Canada; California Cancer Care, Inc., Greenbrae, CA; Caritas St. Elizabeth's Medical Center, Brighton, MA; New York Lung Cancer Alliance, New York, NY; Vermont Cancer Center, Burlington, VT; Columbia University, New York, NY; Merck & Co., Inc, Whitehouse Station, NJ; Merck & Co., Inc, West Point, PA
| | - R. J. Gralla
- Princess Margaret Hospital, Toronto, ON, Canada; California Cancer Care, Inc., Greenbrae, CA; Caritas St. Elizabeth's Medical Center, Brighton, MA; New York Lung Cancer Alliance, New York, NY; Vermont Cancer Center, Burlington, VT; Columbia University, New York, NY; Merck & Co., Inc, Whitehouse Station, NJ; Merck & Co., Inc, West Point, PA
| | - H. Muss
- Princess Margaret Hospital, Toronto, ON, Canada; California Cancer Care, Inc., Greenbrae, CA; Caritas St. Elizabeth's Medical Center, Brighton, MA; New York Lung Cancer Alliance, New York, NY; Vermont Cancer Center, Burlington, VT; Columbia University, New York, NY; Merck & Co., Inc, Whitehouse Station, NJ; Merck & Co., Inc, West Point, PA
| | - H. Raftopolous
- Princess Margaret Hospital, Toronto, ON, Canada; California Cancer Care, Inc., Greenbrae, CA; Caritas St. Elizabeth's Medical Center, Brighton, MA; New York Lung Cancer Alliance, New York, NY; Vermont Cancer Center, Burlington, VT; Columbia University, New York, NY; Merck & Co., Inc, Whitehouse Station, NJ; Merck & Co., Inc, West Point, PA
| | - M. Gabriel
- Princess Margaret Hospital, Toronto, ON, Canada; California Cancer Care, Inc., Greenbrae, CA; Caritas St. Elizabeth's Medical Center, Brighton, MA; New York Lung Cancer Alliance, New York, NY; Vermont Cancer Center, Burlington, VT; Columbia University, New York, NY; Merck & Co., Inc, Whitehouse Station, NJ; Merck & Co., Inc, West Point, PA
| | - A. Rodgers
- Princess Margaret Hospital, Toronto, ON, Canada; California Cancer Care, Inc., Greenbrae, CA; Caritas St. Elizabeth's Medical Center, Brighton, MA; New York Lung Cancer Alliance, New York, NY; Vermont Cancer Center, Burlington, VT; Columbia University, New York, NY; Merck & Co., Inc, Whitehouse Station, NJ; Merck & Co., Inc, West Point, PA
| | - C. M. Hustad
- Princess Margaret Hospital, Toronto, ON, Canada; California Cancer Care, Inc., Greenbrae, CA; Caritas St. Elizabeth's Medical Center, Brighton, MA; New York Lung Cancer Alliance, New York, NY; Vermont Cancer Center, Burlington, VT; Columbia University, New York, NY; Merck & Co., Inc, Whitehouse Station, NJ; Merck & Co., Inc, West Point, PA
| | - F. Skobieranda
- Princess Margaret Hospital, Toronto, ON, Canada; California Cancer Care, Inc., Greenbrae, CA; Caritas St. Elizabeth's Medical Center, Brighton, MA; New York Lung Cancer Alliance, New York, NY; Vermont Cancer Center, Burlington, VT; Columbia University, New York, NY; Merck & Co., Inc, Whitehouse Station, NJ; Merck & Co., Inc, West Point, PA
| |
Collapse
|
20
|
Hesketh PJ, Van Belle S, Aapro M, Tattersall FD, Naylor RJ, Hargreaves R, Carides AD, Evans JK, Horgan KJ. Differential involvement of neurotransmitters through the time course of cisplatin-induced emesis as revealed by therapy with specific receptor antagonists. Eur J Cancer 2003; 39:1074-80. [PMID: 12736106 DOI: 10.1016/s0959-8049(02)00674-3] [Citation(s) in RCA: 195] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Advances in antiemetic therapy for chemotherapy-induced emesis have resulted in improved protection against symptoms occurring within 24 h of chemotherapy. However, the vomiting which tends to occur beyond 24 h after chemotherapy (delayed-phase vomiting) is still relatively poorly controlled by the currently available drugs, suggesting that more than one mechanism may mediate these symptoms. The standard antiemetic regimen currently recommended for prevention of chemotherapy-induced emesis includes a serotonin (5-HT(3)) antagonist and a corticosteroid. The neurokinin-1 (NK(1)) antagonist aprepitant represents a new class of antiemetic currently in clinical development. Using data obtained in 2 Phase II clinical trials of aprepitant in patients receiving chemotherapy based on the highly emetogenic chemotherapeutic agent cisplatin, we compared the time course of antiemetic effect of aprepitant, a 5-HT(3) antagonist, or a combination of both. Over the entire observation period (up to 7 days post-cisplatin), patients who received the NK(1) antagonist had a superior prevention of emesis. However, in the first 24 h after cisplatin, emesis occurred in fewer patients who received the 5-HT(3) antagonist than in patients who did not receive this class of drug. Furthermore, the majority of treatment failures in patients who received the NK(1) antagonist occurred within the first 8-12 h of chemotherapy, whereas the treatment failures in patients who received a 5-HT(3) antagonist were more evenly distributed over time. Patients who received both drugs had superior control of symptoms compared with patients who received one or the other. The difference in the time course of emesis blockade observed with two different classes of receptor antagonists provides substantial evidence for involvement of separate pathophysiological mechanisms in chemotherapy-induced vomiting. Serotonin mediates the early vomiting process that occurs within 8-12 h following cisplatin-based chemotherapy, after which time substance P acting at NK(1) receptors becomes the dominant mediator of vomiting
Collapse
Affiliation(s)
- P J Hesketh
- St. Elizabeth's Medical Center; HOQ-2, Room 225, 736 Cambridge Street, Boston, MA 02135, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
21
|
Ballen KK, Hesketh AM, Heyes C, Becker PS, Emmons RV, Fogarty K, LaPointe J, Liu Q, Hsieh CC, Hesketh PJ. Prospective evaluation of antiemetic outcome following high-dose chemotherapy with hematopoietic stem cell support. Bone Marrow Transplant 2001; 28:1061-6. [PMID: 11781617 DOI: 10.1038/sj.bmt.1703280] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2001] [Accepted: 07/30/2001] [Indexed: 11/09/2022]
Abstract
Considerable progress has been made in improving the control of chemotherapy-induced emesis. The impact of available antiemetic options for patients receiving stem cell transplants is unclear, as few prospective data have been collected. We prospectively evaluated antiemetic outcome in patients receiving stem cell transplantation over a 7-day period following the initiation of chemotherapy. The primary endpoints were the number of emetic episodes and the extent of nausea measured on a four-point scale. Eighty-two patients were evaluated. Ninety-five percent of patients had nausea during the first week of treatment; 80% had at least one emetic episode. The percentage of patients with emesis was as follows: day 1: 13%, day 2: 21%, day 3: 30%, day 4: 38%, day 5: 44%, day 6: 39%, day 7: 18%. In multivariate analysis, gender, emesis with prior chemotherapy, history of morning or motion sickness, type of transplant (auto vs allo), use of total body irradiation, or use of dexamethasone did not effect emesis control. Most patients receiving high-dose chemotherapy experience incompletely controlled emesis. Control of nausea and emesis progressively worsened with each subsequent day following initiation of chemotherapy, reaching a nadir on day 5. New treatment approaches are needed to improve emesis control in this patient population.
Collapse
Affiliation(s)
- K K Ballen
- Department of Medicine, UMass Memorial Health Care, Worcester, MA 01655, USA
| | | | | | | | | | | | | | | | | | | |
Collapse
|
22
|
Abstract
A sensitive conductimetric immunosensor has been demonstrated based on an ultrathin platinum film on an oxidized silicon base. The film is about 25 A thick and is seen to consist of a discontinuous layer with channels 20-30 A wide. Monoclonal antibodies were bound to the sensor surface using conventional biosensor chemistry. Impedance at fixed frequencies across the film was used to track modification and binding at the surface. Impedance increased 55% at 20 Hz during the activation of the surface with anti-alkaline phosphatase (anti-AP). Binding of alkaline phosphatase (AP) to the prepared surface results in a further increase of 12%. p-Nitrophenyl phosphate hydrolysis confirmed binding and activity of the AP. About 40 amol AP were bound on the 0.5 cm(2) electrode. Non-specific binding of horseradish peroxidase caused an impedance change <6%. Control experiments showed small impedance changes and trace enzyme activity. Since the mechanism of electrical conduction of the thin film was not established, modeling of thin-film response was used to distinguish between redox processes, capacitance and tunneling mechanisms. The data fit well with the diffusion distributed elements (DE) model as well as a transmission line distribution element (DX) model. The first model, DE, is distributed elements for diffusion. The second DX model represents a transmission line. The sensors behave in a distributed network or like a transmission line.
Collapse
Affiliation(s)
- S C Pak
- Bioengineering Department, Microfabrication Applications Laboratory, University of Illinois at Chicago, Chicago, IL 60607, USA
| | | | | |
Collapse
|
23
|
Abstract
Better tolerated and more effective means of controlling chemotherapy-induced nausea and vomiting have been introduced over the past decade. Despite the progress made, incompletely controlled emesis is a persistent problem for significant numbers of patients receiving chemotherapy. Efforts to improve antiemetic control further are ongoing. The most interesting new class of antiemetics under development focuses on antagonism of the neurotransmitter substance P. Substance P exerts its effects by binding to the tachykinin neurokinin NK1 receptor. A number of selective antagonists of the NK1 receptor have been synthesized and, when used in preclinical models, have demonstrated an ability to antagonize the emetic effects of a number of stimuli, including chemotherapy agents such as cisplatin. Over the past 3 years, results of the initial studies evaluating this class of agents for cisplatin-induced emesis in cancer patients have begun to appear. These agents have been well tolerated. As single agents, they appear to be no more effective than 5-HT3 receptor antagonists in preventing acute cisplatin-induced emesis. Their real value may be found in combination with existing agents and in the treatment of delayed emesis. The results of ongoing clinical trials will hopefully define the utility and appropriate place for this new class of agents in the management of chemotherapy-induced nausea and vomiting.
Collapse
Affiliation(s)
- P J Hesketh
- Division of Hematology Oncology, St. Elizabeth's Medical Center, Boston, MA 02135-2907, USA
| |
Collapse
|
24
|
Safran H, Gaissert H, Akerman P, Hesketh PJ, Chen MH, Moore T, Koness J, Graziano S, Wanebo HJ. Paclitaxel, cisplatin, and concurrent radiation for esophageal cancer. Cancer Invest 2001; 19:1-7. [PMID: 11291548 DOI: 10.1081/cnv-100000068] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Paclitaxel is an active agent for adenocarcinomas and squamous cell carcinomas of the esophagus and is a radiation sensitizer. We sought to investigate the toxicity and complete response rate of paclitaxel, cisplatin, and concurrent radiation for esophageal cancer. Forty-one patients with esophageal cancer were studied, 29 with adenocarcinomas and 12 with squamous cell cancers. Twelve patients had tumor extension into the proximal stomach and/or abdominal adenopathy. Patients received paclitaxel 60 mg/m2 by 3-hour intravenous (i.v.) infusion, and cisplatin 25 mg/m2 weekly on days 1, 8, 15, and 22. Radiation was administered concurrently to a total dose of 39.60 Gy, in 1.80 Gy fractions, for 22 treatments. Patients with medical or surgical contraindications to esophagectomy received 2 additional weeks of paclitaxel with a radiation boost to 50.4 Gy. Neutropenia was the most common grade 3/4 toxicity occurring in 10 patients (24%). Only 2 patients (5%) had grade 4 esophagitis requiring parenteral nutrition. Twelve patients (29%) obtained a complete response. The 2-year progression-free and overall survival rates were 40% and 42%, respectively. Esophagitis was less severe than expected and prophylactic enteral feeding tubes were not necessary. Additional effective systemic treatments are needed to reduce the development of distant metastases.
Collapse
Affiliation(s)
- H Safran
- Brown University Oncology Group, Providence, Rhode Island.
| | | | | | | | | | | | | | | | | |
Collapse
|
25
|
Ioannidis JP, Hesketh PJ, Lau J. Contribution of dexamethasone to control of chemotherapy-induced nausea and vomiting: a meta-analysis of randomized evidence. J Clin Oncol 2000; 18:3409-22. [PMID: 11013282 DOI: 10.1200/jco.2000.18.19.3409] [Citation(s) in RCA: 141] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To synthesize the available randomized evidence on the efficacy of dexamethasone when used for protection against acute and delayed nausea and vomiting in patients receiving highly or moderately emetogenic cancer chemotherapy. MATERIALS AND METHODS A meta-analysis was performed using trials identified through MEDLINE (1966 to April 1999), Embase, Derwent Drug File, and the Cochrane Library's Database of Controlled Trials. Data on acute and delayed emesis and nausea were collected. All randomized studies comparing dexamethasone to placebo, no treatment, or other antiemetics qualified, including cross-over trials providing first-cycle data. RESULTS Of 1,200 citations screened, 32 studies with 42 pertinent comparisons and 5,613 patients were included in the meta-analysis. Dexamethasone was superior to placebo or no treatment for complete protection from acute emesis (odds ratio, 2.22; 95% confidence interval [CI], 1.89 to 2.60) and for complete protection from delayed emesis (odds ratio, 2.04; 95% CI, 1.63 to 2.56). The results were similar for complete protection from nausea. The pooled risk difference for complete protection from emesis was 16% for both the acute and delayed phases (95% CI, 13% to 19% and 11% to 20%, respectively). The beneficial effect was similar in subgroups defined by various study design parameters. No trial addressed the efficacy of dexamethasone in the delayed phase without having administered dexamethasone for acute-phase protection as well. CONCLUSION Dexamethasone is clearly effective in protecting from emesis both in the acute and delayed phases, with emesis avoided in one patient out of six treated. Future trials should determine whether the delayed-phase effect is independent of the acute-phase benefit.
Collapse
Affiliation(s)
- J P Ioannidis
- Clinical Trials and Evidence-Based Medicine Unit, Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece
| | | | | |
Collapse
|
26
|
Hesketh PJ, Crews JR, Cohen R, Blackburn LM, Friedman CJ. Antiemetic efficacy of single-dose oral granisetron (1 mg vs 2 mg) with moderately emetogenic chemotherapy. Cancer J 2000; 6:157-61. [PMID: 10882331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
PURPOSE To compare the efficacy of oral granisetron, 1 mg and 2 mg, administered as one dose in patients who receive moderately emetogenic chemotherapy. PATIENTS AND METHODS Chemotherapy-naïve patients, scheduled to receive intravenous cyclophosphamide (500 to 1200 mg/m2) or carboplatin (> or = 300 mg/m2), were stratified by dexamethasone/methylprednisolone use (+ DEX, n = 92) or nonuse (- DEX, n = 5). Patients were randomized to one dose of either 1 mg (n = 48) or 2 mg (n = 49) of granisetron administered 60 minutes before chemotherapy. Known important prognostic variables (gender, age, alcohol) were well balanced between groups. RESULTS Using the most rigorous criterion of total control (no emetic episodes, no nausea, no rescue therapy during the first 24 hours), response rates were 54.2% (26/48) and 57.1% (28/49) in patients receiving 1 mg and 2 mg of granisetron, respectively (95% confidence interval, -0.17, 0.23). Total control rates in patients who received 1 mg and 2 mg of granisetron + DEX were also comparable: 57.8% (26/45) and 55.3% (26/47), respectively. Response rates were similar for the parameters of nausea, emesis, and complete response (no emetic episodes, no more than mild nausea, no antiemetic rescue). Among all patients, one (2.1%) who received 1 mg of granisetron and three (6.1%) who received 2 mg experienced severe nausea. The proportions of 1- and 2-mg-treated patients who received rescue therapy within the first 24 hours were 31.3% (15/48) and 34.7% (17/49), respectively. Reported adverse experiences were generally mild in severity. DISCUSSION The results of this trial demonstrate good control of emesis with a single 1-mg dose of oral granisetron, with efficacy that compares favorably with that of a 2-mg dose.
Collapse
Affiliation(s)
- P J Hesketh
- Division of Hematology/Oncology, St. Elizabeth's Medical Center, Boston, Massachusetts 02135-2997, USA
| | | | | | | | | |
Collapse
|
27
|
Abstract
Since their introduction, 5-HT3 receptor antagonists have become the agents of choice in the prevention of acute chemotherapy-induced nausea and vomiting and are generally superior to high-dose metoclopramide regimens. The availability of four different agents (ondansetron, granisetron, dolasetron, and tropisetron) within this class has prompted investigations into potential differences between the drugs, which appear to be few. More importantly, the results of recently conducted randomized comparative trials in patients receiving moderately or highly emetogenic chemotherapy have demonstrated similar efficacy. Although study designs and patient populations differed, seven large comparative trials in patients receiving highly emetogenic chemotherapy reported no significant differences in complete or complete plus major response rates among the agents. Similar results were generally reported in trials evaluating patients receiving moderately emetogenic chemotherapy. The safety and tolerability of these agents also appear to be similar. The most common adverse events include headache, gastrointestinal effects, lightheadedness, and sedation. All agents are available in both intravenous and oral dosage forms and may be administered as a single dose.
Collapse
Affiliation(s)
- P J Hesketh
- Division of Hematology/Oncology, St. Elizabeth's Medical Center, Boston, Massachusetts, USA
| |
Collapse
|
28
|
Safran H, Wanebo HJ, Hesketh PJ, Akerman P, Ianitti D, Cioffi W, DiPetrillo T, Wolf B, Koness J, McAnaw R, Moore T, Chen MH, Radie-Keane K. Paclitaxel and concurrent radiation for gastric cancer. Int J Radiat Oncol Biol Phys 2000; 46:889-94. [PMID: 10705010 DOI: 10.1016/s0360-3016(99)00436-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
PURPOSE To determine the activity and toxicity of paclitaxel and concurrent radiation for gastric cancer. METHODS AND MATERIALS Twenty-seven patients were studied. Twenty-five had proximal gastric cancers, two had distal cancers. Eight had esophageal extension, 6 had celiac adenopathy, and 7 had retroperitoneal adenopathy. Patients received paclitaxel, 50 mg/m(2) by 3-hour intravenous (IV) infusion, weekly, on days 1, 8, 15, 22, and 29. Radiation was administered concurrently to a total dose of 45.0 Gy, in 1.80 Gy fractions, for 25 treatments. Patients who were medically or surgically inoperable received a sixth week of paclitaxel with a radiation boost to 50.4 Gy. RESULTS Esophagitis and gastritis were the most important toxicities, Grade 3 in four patients (15%), and Grade 4 in three patients (11%). Five patients (19%) had Grade 3 nausea. The overall response rate was 56%, including three patients (11%) with a complete response. The 2-year progression-free and overall survival rates were 29% and 31%, respectively. CONCLUSION Concurrent paclitaxel and radiation demonstrates substantial local-regional activity in gastric cancer. Future investigations combining paclitaxel and radiation with other local-regional and systemic treatments are warranted.
Collapse
Affiliation(s)
- H Safran
- The Brown University Oncology Group, Providence, RI 02906, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
29
|
Hesketh PJ, Roman A, Hesketh AM, Perez EA, Edelman M, Gandara DR. Control of high-dose-cisplatin-induced emesis with an all-oral three-drug antiemetic regimen. Support Care Cancer 2000; 8:46-8. [PMID: 10650897 DOI: 10.1007/s005209900077] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
In this pilot trial, the antiemetic efficacy and tolerability of an all-oral antiemetic combination in the prevention of both acute and delayed nausea and vomiting following high-dose cisplatin was evaluated. Fifty-two patients receiving cisplatin (median dose 100 mg/m2) were entered. Patients received (1) 60 min prior to cisplatin: prochlorperazine spansule 15 mg, dexamethasone 20 mg, granisetron 2 mg; (2) 12 h after cisplatin: prochlorperazine spansule 15 mg, dexamethasone 10 mg; (3) on days 2 and 3: prochlorperazine spansule 15 mg b.i.d., dexamethasone 8 mg b.i.d.; (4) on days 4 and 5: dexamethasone 4 mg b.i.d. All antiemetics were administered orally. The study period was the 120 h after cisplatin administration. The primary efficacy end-point was complete control (no vomiting, retching or antiemetic rescue) of delayed emesis (24-120 h after cisplatin). Complete control of delayed emesis was achieved in 26 patients (53%). Nineteen patients (39%) noted no delayed nausea. Complete control of acute emesis (24 h after cisplatin) was attained in 44 patients (86%). The no nausea rate during the first 24 h was 74%. Overall, 39 patients (80%) were satisfied or very satisfied with their outcome. Treatment was well tolerated with infrequent and minor adverse events. In conclusion, an all-oral combination of granisetron, dexamethasone and prochlorperazine is a highly effective and well-tolerated regimen for preventing acute cisplatin-induced emesis. Control of delayed emesis was not better than with current standard treatment, and more effective approaches are needed.
Collapse
Affiliation(s)
- P J Hesketh
- Division of Hematology-Oncology, St. Elizabeth's Medical Center, Boston, MA 02135-2907, USA.
| | | | | | | | | | | |
Collapse
|
30
|
Abstract
Significant progress has been made in recent years in developing more effective means of preventing nausea and vomiting induced by cancer chemotherapy. With appropriate application of currently available antiemetic regimens, the majority of patients with cancer who are receiving chemotherapy can anticipate experiencing no emesis during their treatment. Nevertheless, incompletely controlled emesis remains a problem for a significant percentage of patients. Persistent challenges include delayed emesis and emesis following high-dose chemotherapy regimens. The goal of complete prevention of emesis in all patients remains elusive. Therefore, there is a strong rationale for investigating new antiemetic approaches. New antiemetic agents currently under development target the neurotransmitters serotonin (5-hydroxytryptamine; 5-HT) and substance P. A number of new selective antagonists of serotonin 5-HT3 receptors are in clinical trials. Given the lack of clinically significant differences between the available 5-HT3 receptor antagonists, it appears unlikely that any of these new agents will have substantial advantages over currently approved agents. Several other serotonin receptors have been targeted including the 5-HT4, 5-HT1A and 5-HT2A receptors. Of these approaches, only agonism of the 5-HT1A receptor has produced an agent that has proceeded into clinical testing. The most exciting new class of antiemetics currently under development focuses on antagonism of the effects of the neurotransmitter substance P. Results of early clinical trials with tachykinin neurokinin NK1 receptor antagonists demonstrate enhanced control of acute emesis with their addition to currently available agents and promising activity in controlling delayed emesis. Available evidence would strongly suggest that this class of agents will represent the next important advance in efforts to control nausea and vomiting induced by chemotherapy.
Collapse
Affiliation(s)
- A N Rizk
- St Elizabeth's Medical Center, Boston, Massachusetts, USA
| | | |
Collapse
|
31
|
Gralla RJ, Osoba D, Kris MG, Kirkbride P, Hesketh PJ, Chinnery LW, Clark-Snow R, Gill DP, Groshen S, Grunberg S, Koeller JM, Morrow GR, Perez EA, Silber JH, Pfister DG. Recommendations for the use of antiemetics: evidence-based, clinical practice guidelines. American Society of Clinical Oncology. J Clin Oncol 1999; 17:2971-94. [PMID: 10561376 DOI: 10.1200/jco.1999.17.9.2971] [Citation(s) in RCA: 536] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- R J Gralla
- American Society of Clinical Oncology, Alexandria, VA 22314, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
32
|
Hesketh PJ. Defining the emetogenicity of cancer chemotherapy regimens: relevance to clinical practice. Oncologist 1999; 4:191-6. [PMID: 10394587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/13/2023] Open
Abstract
Significant progress has been made in recent years in developing more effective and better tolerated means to prevent nausea and vomiting induced by cancer chemotherapy. The most significant development has been the introduction of a new class of antiemetic agents, the selective antagonists of the type 3 serotonin receptor. With the new antiemetic therapeutic options and their attendant higher costs has come a need to define evidence-based guidelines to assist in their judicious and cost-effective use. A number of predictive factors for antiemetic risk have been defined. Some of these factors relate to the patient population (age, gender, history of ethanol consumption, and prior experience with chemotherapy), and some relate to the treatments administered. Clearly, the most important of all these factors in predicting risk of emesis is the intrinsic emetogenicity of the chemotherapy. Although an "ideal" emetogenic classification schema for chemotherapy has yet to be realized, recent developments in this area have allowed a more precise estimation of emetogenic risks and have provided antiemetic guideline groups with a useful foundation on which to base their treatment recommendations.
Collapse
Affiliation(s)
- P J Hesketh
- Division of Hematology/Oncology, St. Elizabeth's Medical Center, Boston, Massachusetts 02135, USA.
| |
Collapse
|
33
|
Hesketh PJ, Crowley JJ, Burris HA, Williamson SK, Balcerzak SP, Peereboom D, Goodwin JW, Gross HM, Moore DF, Livingston RB, Gandara DR. Evaluation of docetaxel in previously untreated extensive-stage small cell lung cancer: a Southwest Oncology Group phase II trial. Cancer J Sci Am 1999; 5:237-41. [PMID: 10439170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
PURPOSE This phase II multi-institutional trial of the Southwest Oncology Group was designed to evaluate the efficacy and toxicity of docetaxel in chemotherapy-naive patients with extensive-stage small cell lung cancer. PATIENTS AND METHODS Forty-seven patients with extensive-stage small cell lung cancer were entered onto the study. Treatment consisted of docetaxel, 100 mg/m2, as a 1-hour intravenous infusion repeated every 21 days, with protocol-specified dose reductions for toxicity. RESULTS Forty-three patients were eligible. A total of 158 cycles of docetaxel were administered (median, three cycles; range, one to nine). Ten patients (23%) (95% confidence interval, 12% to 39%) achieved partial responses. The median progression-free and overall survivals were 3 and 9 months, respectively. Therapy was generally well tolerated. Grade 4 neutropenia occurred in 58% of patients. Febrile neutropenia developed in five patients (12%), and infection was documented in 14% of patients. There was one treatment-related death caused by pneumonia in a patient who had developed bilateral pneumothoraces. Other toxicities (grade 3/4) included malaise, fatigue, and lethargy (21%); nausea (19%); stomatitis (14%); edema (9%); and sensory neuropathy (9%). DISCUSSION Docetaxel, at a dose of 100 mg/m2, is an active agent in the treatment of small cell lung cancer. Reversible neutropenia is the most common toxicity associated with this treatment. The overall survival (9 months) with this agent is comparable to that reported with other new chemotherapeutic agents in small cell lung cancer and warrants additional evaluation of docetaxel in combination therapy.
Collapse
Affiliation(s)
- P J Hesketh
- St. Elizabeth's Medical Center, Boston, Massachusetts, USA
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
34
|
Safran H, Akerman P, Cioffi W, Gaissert H, Joseph P, King T, Hesketh PJ, Wanebo H. Paclitaxel and concurrent radiation therapy for locally advanced adenocarcinomas of the pancreas, stomach, and gastroesophageal junction. Semin Radiat Oncol 1999; 9:53-7. [PMID: 10210540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
An effective locoregional therapy is needed for adenocarcinomas of the pancreas, stomach, and gastroesophageal junction. Paclitaxel (Taxol; Bristol-Myers Squibb Company, Princeton, NJ) may enhance the effect of radiation therapy (RT). Paclitaxel synchronizes cells at G2/M, a relatively radiosensitive phase of the cell cycle. We have shown that response to paclitaxel and concurrent RT (paclitaxel/RT) was not affected by p53 mutations in non-small cell lung cancer. This finding suggested that paclitaxel/RT was a rational treatment approach for other malignancies that frequently harbor p53 mutations, such as upper gastrointestinal malignancies. We completed a phase I study of paclitaxel/RT for locally advanced pancreatic and gastric cancer. The maximum tolerated dose of paclitaxel was 50 mg/m2/wk for 6 weeks with abdominal RT. The dose-limiting toxicities were abdominal pain within the radiation field, nausea, and anorexia. Phase II studies are now under way. Twenty-five patients with locally advanced pancreatic cancer have been entered at the phase II dose level of paclitaxel 50 mg/m2/wk with concurrent RT (total dose, 50 Gy). Thus far, the only grade 3/4 toxicities have been hypersensitivity reactions (n = 2), asymptomatic grade 4 neutropenia (n = 3), and nonneutropenic biliary sepsis (n = 1). Of the first 18 assessable patients with pancreatic cancer treated on the phase II study, six obtained a partial response, for a preliminary response rate of 33%. In the phase II study for locally advanced gastric cancer, 20 patients have been enrolled. Of the first 19 patients who have completed treatment, nine (47%) had grade 3/4 toxicities, including nausea, anorexia, esophagitis, and gastritis. Of the first 16 patients with gastric cancer, complete and partial responses have been observed in one and eight patients, respectively, for a preliminary response rate of 56%. We have also completed treatment on 24 patients with potentially resectable adenocarcinomas of the gastroesophageal junction with neoadjuvant paclitaxel 60 mg/m2 and cisplatin 25 mg/m2, weekly for 4 weeks, with concurrent RT (total dose, 40 Gy) followed by surgical resection. Ten patients (41%) had grade 3/4 toxicities, including neutropenia, nausea, and dehydration. Of 24 patients, four complete responses (17%) and 14 partial responses (58%) were observed, for an overall response rate of 75%. Severe esophagitis was uncommon, making this a well-tolerated outpatient regimen for adenocarcinomas of the distal esophagus. These findings demonstrate that paclitaxel-based chemoradiation for locally advanced upper gastrointestinal malignancies is well-tolerated with substantial activity.
Collapse
Affiliation(s)
- H Safran
- Department of Medicine, Brown University Oncology Group, Providence, RI, USA
| | | | | | | | | | | | | | | |
Collapse
|
35
|
Navari RM, Reinhardt RR, Gralla RJ, Kris MG, Hesketh PJ, Khojasteh A, Kindler H, Grote TH, Pendergrass K, Grunberg SM, Carides AD, Gertz BJ. Reduction of cisplatin-induced emesis by a selective neurokinin-1-receptor antagonist. L-754,030 Antiemetic Trials Group. N Engl J Med 1999; 340:190-5. [PMID: 9917226 DOI: 10.1056/nejm199901213400304] [Citation(s) in RCA: 251] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND The localization of substance P in brain-stem regions associated with vomiting, and the results of studies in ferrets, led us to postulate that a neurokinin-1-receptor antagonist would be an antiemetic in patients receiving anticancer chemotherapy. METHODS In a multicenter, double-blind, placebo-controlled trial involving 159 patients who had not previously received cisplatin, we evaluated the prevention of acute emesis (occurring within 24 hours) and delayed emesis (on days 2 to 5) after a single dose of cisplatin therapy (70 mg or more per square meter of body-surface area). Before receiving cisplatin, all the patients received granisetron (10 microg per kilogram of body weight intravenously) and dexamethasone (20 mg orally). The patients were randomly assigned to one of three treatments in addition to granisetron and dexamethasone: 400 mg of an oral trisubstituted morpholine acetal (also known as L-754,030) before cisplatin and 300 mg on days 2 to 5 (group 1), 400 mg of L-754,030 before cisplatin and placebo on days 2 to 5 (group 2), or placebo before cisplatin and placebo on days 2 to 5 (group 3). Additional medication was available at any time to treat occurrences of vomiting or nausea. RESULTS In the acute-emesis phase, 93 percent of the patients in groups 1 and 2 combined and 67 percent of those in group 3 had no vomiting (P<0.001). In the delayed-emesis phase, 82 percent of the patients in group 1, 78 percent of those in group 2, and 33 percent of those in group 3 had no vomiting (P<0.001 for the comparison between group 1 or 2 and group 3). The median nausea score in the delayed-emesis phase was significantly lower in group 1 than in group 3 (P=0.003). No serious adverse events were attributed to L-754,030. CONCLUSIONS The neurokinin-1-receptor antagonist L-754,030 prevents delayed emesis after treatment with cisplatin. Moreover, combining L-754,030 with granisetron plus dexamethasone improves the prevention of acute emesis.
Collapse
Affiliation(s)
- R M Navari
- Simon-Williamson Clinic, Birmingham, Ala, USA
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
36
|
Hesketh PJ, Gralla RJ, Webb RT, Ueno W, DelPrete S, Bachinsky ME, Dirlam NL, Stack CB, Silberman SL. Randomized phase II study of the neurokinin 1 receptor antagonist CJ-11,974 in the control of cisplatin-induced emesis. J Clin Oncol 1999; 17:338-43. [PMID: 10458252 DOI: 10.1200/jco.1999.17.1.338] [Citation(s) in RCA: 87] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To determine the efficacy and safety of the neurokinin type 1 receptor antagonist CJ-11,974 for the control of high-dose cisplatin-induced emesis. PATIENTS AND METHODS A double-blind, randomized, phase II design with a group sequential stopping rule was used in this study. Sixty-one patients with cancer who were receiving cisplatin at a dose of at least 100 mg/m2 for the first time were enrolled. All patients received granisetron 10 microg/kg and dexamethasone 20 mg intravenously 30 minutes before they were given cisplatin. Patients were randomly assigned to two groups: group 1 received CJ-11,974 100 mg, and group 2 received placebo orally 30 minutes before and 12 hours after cisplatin and then twice daily on days 2 through 5 after cisplatin. The primary end point was the percentage of patients who developed delayed emesis (emesis on the second to fifth days after cisplatin). RESULTS Thirty patients were enrolled in group 1, and 31 patients were enrolled in group 2. Fifty-eight patients were assessable for efficacy. Complete control of emesis (expressed as the percentage of patients who had no emesis) was as follows: day 1, 85.7% (group 1) and 66.7% (group 2) (P = .090); days 2 through 5, 67.8% (group 1) and 36.6% (group 2) (P = .0425, adjusted); days 1 through 5, 64.3% (group 1) and 30% (group 2) (P = .009). Patients in group 1 experienced significantly less nausea than patients in group 2 on day 1 (P = .024). Treatment was well tolerated in both groups. CONCLUSION We conclude from this exploratory phase II trial that CJ-11,974 is superior to placebo in controlling cisplatin-induced delayed emesis and may provide additive benefit in acute emesis and nausea control when combined with a 5-hydroxytryptamine-3 receptor antagonist and dexamethasone. Additional larger trials are indicated to confirm the clinical value of CJ-11,974.
Collapse
Affiliation(s)
- P J Hesketh
- Section of Medical Oncology, St. Elizabeth's Medical Center, Boston, MA 02135, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
37
|
Whitmore JB, Kris MG, Hesketh PJ, Grote TH, DuBois DM, Cramer MB, Hahne WF. Rationale for the use of a single fixed intravenous dolasetron dose for the prevention of cisplatin-induced nausea and vomiting. Pooled analysis of 14 clinical trials. Support Care Cancer 1998; 6:473-8. [PMID: 9773466 DOI: 10.1007/s005200050197] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Dolasetron mesilate is a selective 5-HT3 receptor antagonist that prevents chemotherapy-induced and postoperative nausea and vomiting. For the majority of patients in intravenous dolasetron trials for chemotherapy-induced nausea and vomiting, dosing has been based on body weight (mg/kg). The approved weight-based dose is 1.8 mg/kg based on results of controlled clinical trials. However, trials of dolasetron evaluating oral doses for prevention of chemotherapy-induced emesis, and intravenous doses for prevention and treatment of postoperative emesis have used a fixed milligram dose. To identify an appropriate intravenous fixed milligram dose for the prevention of chemotherapy-induced nausea and vomiting, this analysis was performed to derive efficacy results for fixed milligram doses from pooled results obtained with dosing based on body weight. Intravenous dolasetron doses for 1,598 patients treated on a mg/kg basis (0.3, 0.6, 1.2, 1.8, 2.4, 3.0 and 5.0 mg/kg) in 14 clinical trials were converted to fixed milligram doses based on weight. Fixed-dose groups were established at doses of 50, 75, 100, 125, 150, and 200 mg. Doses less than or equal to the midpoint between two dose groups were included in the lower dose group. Pooled results showed that the 100 mg intravenous dolasetron dose group (who received actual doses of 88-112 mg) produced the highest rate (53%) of complete response (0 emetic episodes and no rescue medication in the 24-h period following initiation of chemotherapy).
Collapse
Affiliation(s)
- J B Whitmore
- Immunex Corporation, Seattle, WA 98101-2936, USA.
| | | | | | | | | | | | | |
Collapse
|
38
|
Hesketh PJ, Gralla RJ, du Bois A, Tonato M. Methodology of antiemetic trials: response assessment, evaluation of new agents and definition of chemotherapy emetogenicity. Support Care Cancer 1998; 6:221-7. [PMID: 9629873 DOI: 10.1007/s005200050157] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Establishing appropriate and practical methodology is a key to progress in the investigation of chemotherapy-induced nausea and vomiting. Critical issues include patient response assessment, proper trial design for evaluating new agents, and the definition of chemotherapy emetogenicity. In assessing antiemetic response, the primary end-point should be complete control of emesis and nausea. Emesis and nausea should be independently assessed with the period of observation defined (acute, delayed, anticipatory). Emesis can be evaluated by measuring the number of emetic episodes either by direct observation or by patient self-report using patient-completed diaries. Nausea should be measured by patient self-report with the standard parameters, including frequency and intensity. New antiemetic drug development should proceed in an orderly progression from open-label phase I-II trials defining tolerance and minimally fully effective dose to phase III comparative trials. A randomized, parallel, double-blind study is the preferred design for the latter, and the comparator arm should always include the current best available treatment. Antiemetic placebos are no longer acceptable with chemotherapy regimens known to produce emesis in a majority of patients. None of the emetogenic classifications proposed to date adequately accounts for all known important patient- and treatment-related prognostic variables. A modification of a recently reported schema is proposed for use in making antiemetic treatment recommendations and defining the emetogenic challenge in clinical trials.
Collapse
Affiliation(s)
- P J Hesketh
- Section of Medical Oncology, St. Elizabeth's Medical Center, Boston, MA 02135, USA
| | | | | | | |
Collapse
|
39
|
Gralla RJ, Navari RM, Hesketh PJ, Popovic W, Strupp J, Noy J, Einhorn L, Ettinger D, Bushnell W, Friedman C. Single-dose oral granisetron has equivalent antiemetic efficacy to intravenous ondansetron for highly emetogenic cisplatin-based chemotherapy. J Clin Oncol 1998; 16:1568-73. [PMID: 9552067 DOI: 10.1200/jco.1998.16.4.1568] [Citation(s) in RCA: 70] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
PURPOSE To compare the antiemetic efficacy of a single dose of an oral antiemetic (granisetron 2 mg) with a single dose of an intravenous (i.v.) antiemetic (ondansetron 32 mg) given before cisplatin-based chemotherapy. PATIENTS AND METHODS This was a multicenter, randomized, double-blind, parallel-group study. Patients (N = 1,054) scheduled to receive cisplatin (> or = 60 mg/m2)-based chemotherapy were randomized to receive either 2 mg of oral granisetron tablets 1 hour before chemotherapy (n = 534) or i.v. ondansetron (32 mg) 30 minutes before chemotherapy (n = 520). The primary efficacy end point was total control (no emesis, no nausea, and no use of antiemetic rescue medication) over the initial 24 hours after the start of chemotherapy. Dexamethasone or methylprednisolone were permitted, but not required, as concomitant prophylactic antiemetics. RESULTS Total control was equivalent 24 hours after cisplatin chemotherapy for single-dose oral granisetron (54.7%) and i.v. ondansetron (58.3%) (95% confidence interval [CI], -9.6 to 2.4). Similar proportions of patients remained nausea-free in the granisetron group (55.4%) and the ondansetron group (59%) (95% CI, -9.6 to 2.4). The rate of complete control of emesis was 61.2% in the granisetron group and 67.1% in the ondansetron group (95% CI, -11.7 to -0.1). Both treatment regimens were well tolerated, with similar patterns of adverse reactions, generally of a mild degree. The most common side effects included constipation (14%), headache (15%), and diarrhea (10%). CONCLUSION Oral granisetron, administered as a single 2-mg dose, provided equivalent total antiemetic control when compared with i.v. ondansetron (32 mg) in patients who received highly emetogenic, cisplatin-based chemotherapy.
Collapse
Affiliation(s)
- R J Gralla
- Ochsner Cancer Institute, New Orleans, LA 70121, USA.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
40
|
Kris MG, Radford JE, Pizzo BA, Inabinet R, Hesketh A, Hesketh PJ. Use of an NK1 receptor antagonist to prevent delayed emesis after cisplatin. J Natl Cancer Inst 1997; 89:817-8. [PMID: 9182982 DOI: 10.1093/jnci/89.11.817] [Citation(s) in RCA: 75] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
|
41
|
Hesketh PJ, Gandara DR, Hesketh AM, Edelman M, Webber LM, McManus M, Hainsworth JD. Improved control of high-dose-cisplatin-induced acute emesis with the addition of prochlorperazine to granisetron/dexamethasone. Cancer J Sci Am 1997; 3:180-3. [PMID: 9161784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE To evaluate the antiemetic efficacy and safety of adding the dopamine antagonist prochlorperazine to the combination of granisetron and dexamethasone in the prevention of acute nausea and vomiting following high-dose cisplatin. PATIENTS AND METHODS Sixty patients receiving cisplatin (> or = 75 mg/m2) (median dose = 100 mg/m2) were enrolled at three sites. Patients received prochlorperazine spansule 15 mg orally, 60 minutes prior to and 12 hours after cisplatin; dexamethasone 20 mg intravenously, 45 minutes prior to cisplatin, and 10 mg intravenously or orally, 12 hours after cisplatin; and granisetron 10 micrograms/kg intravenously, 30 minutes prior to cisplatin. Efficacy was assessed during the 24-hour period after cisplatin using complete antiemetic response (no emetic episodes and no rescue antiemetics) and patient assessment of nausea and satisfaction using 100-mm visual analog scales (nausea: 0 = none, 100 = nausea as bad as it can be; satisfaction: 0 = not at all satisfied, 100 = satisfied as can be). RESULTS Complete response (0 emetic episodes) was noted in 84% (49/58) of patients. Forty-two patients (72%) experienced no nausea. The mean change in posttreatment nausea visual analog scales from baseline was 8.9 mm. Forty-eight patients (83%) were completely satisfied with their antiemetic treatment. The mean posttreatment patient satisfaction score was 92 mm. Treatment was well tolerated, with infrequent and minor adverse events. CONCLUSIONS This three-drug antiemetic regimen is well tolerated and highly effective in the prevention of acute nausea and vomiting arising from high-dose cisplatin. Further studies evaluating this regimen are warranted.
Collapse
Affiliation(s)
- P J Hesketh
- Section of Medical Oncology, St. Elizabeth's Medical Center, Boston, MA 02135, USA
| | | | | | | | | | | | | |
Collapse
|
42
|
Rubenstein EB, Gralla RJ, Hainsworth JD, Hesketh PJ, Grote TH, Modiano MR, Khojasteh A, Kalman LA, Benedict CR, Hahne WF. Randomized, double blind, dose-response trial across four oral doses of dolasetron for the prevention of acute emesis after moderately emetogenic chemotherapy. Oral Dolasetron Dose-Response Study Group. Cancer 1997; 79:1216-24. [PMID: 9070501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND This double blind parallel group study assessed the acute antiemetic efficacy of four oral doses of dolasetron mesylate in cancer patients receiving their first course of intravenous chemotherapy with doxorubicin and/or cyclophosphamide. METHODS Patients were randomized to receive 25, 50, 100, or 200 mg of dolasetron mesylate 30 minutes prior to chemotherapy and were monitored for nausea and emetic episodes for the next 24 hours. RESULTS Three hundred and nineteen cancer patients at 32 sites completed the study. Most patients were female (81%); of this group, 69% had breast carcinoma. A highly statistically significant linear trend demonstrating improved response with higher doses was detected for complete response (no emetic episodes and no rescue medication) (P < 0.001), for complete plus major response (0-2 emetic episodes and no rescue medication) (P < 0.001), and for patient visual analog scale assessments of nausea (P = 0.001) and general satisfaction with antiemetic therapy (P = 0.001). No serious adverse events were noted. The most frequent adverse event was mild, self-limiting headache, which has been reported with other drugs in this class. CONCLUSIONS Single oral doses of dolasetron mesylate were found to be effective in preventing acute emesis in cancer patients receiving moderately emetogenic chemotherapy.
Collapse
|
43
|
Safran H, King TP, Choy H, Hesketh PJ, Wolf B, Altenhein E, Sikov W, Rosmarin A, Akerley W, Radie-Keane K, Cicchetti G, Lopez F, Bland K, Wanebo HJ. Paclitaxel and concurrent radiation for locally advanced pancreatic and gastric cancer: a phase I study. J Clin Oncol 1997; 15:901-7. [PMID: 9060526 DOI: 10.1200/jco.1997.15.3.901] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE To determine the maximum-tolerated dose (MTD), dose-limiting toxicities, and potential antitumor activity of weekly paclitaxel with concurrent radiation (RT) for locally advanced pancreatic and gastric cancer. PATIENTS AND METHODS Thirty-four patients with locally advanced adenocarcinoma of the pancreas or stomach were studied. The initial dose of paclitaxel was 30 mg/m2 by 3-hour intravenous (I.V.) infusion repeated every week for 6 weeks with 50 Gy RT. Doses were escalated at 10-mg/m2 increments in successive cohorts of three new patients until dose-limiting toxicity was observed. RESULTS The dose-limiting toxicities at 60 mg/m2/wk were abdominal pain within the RT field, nausea, and anorexia. Of 23 patients with assessable disease, 11 (seven with gastric, four with pancreatic cancer) had objective responses for an overall response rate of 48%. CONCLUSION Concurrent paclitaxel with upper abdominal RT is well tolerated at dosages that have substantial activity. A phase II trial of neoadjuvant paclitaxel and RT at the MTD of 50 mg/m2/wk is underway.
Collapse
Affiliation(s)
- H Safran
- Brown University, Providence, RI, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
44
|
Hesketh PJ, Kris MG, Grunberg SM, Beck T, Hainsworth JD, Harker G, Aapro MS, Gandara D, Lindley CM. Proposal for classifying the acute emetogenicity of cancer chemotherapy. J Clin Oncol 1997; 15:103-9. [PMID: 8996130 DOI: 10.1200/jco.1997.15.1.103] [Citation(s) in RCA: 416] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE To propose a classification of the acute emetogenicity of antineoplastic chemotherapy agents, and to develop an algorithm to define the emetogenicity of combination chemotherapy regimens. METHODS A Medline search was conducted to identify (1) clinical trials that used chemotherapy as single-agent therapy, and (2) major reviews of antiemetic therapy. The search was limited to patients who received commonly used doses of chemotherapy agents, primarily by short (< 3 hours) intravenous infusions. Based on review of this information and our collective clinical experience, we assigned chemotherapy agents to one of five emetogenic levels by consensus. A preliminary algorithm to determine the emetogenicity of combination chemotherapy regimens was then designed by consensus. A final algorithm was developed after we analyzed a data base composed of patients treated on the placebo arms of four randomized antiemetic trials. RESULTS Chemotherapy agents were divided into five levels: level 1 (< 10% of patients experience acute [< or = 24 hours after chemotherapy] emesis without antiemetic prophylaxis); level 2 (10% to 30%); level 3 (30% to 60%); level 4 (60% to 90%); and level 5 (> 90%). For combinations, the emetogenic level was determined by identifying the most emetogenic agent in the combination and then assessing the relative contribution of the other agents. The following rules apply: (1) level 1 agents do not contribute to the emetogenic level of a combination; (2) adding > or = one level 2 agent increases the emetogenicity of the combination by one level greater than the most emetogenic agent in the combination; and (3) adding level 3 or 4 agents increases the emetogenicity of the combination by one level per agent. CONCLUSION The proposed classification schema provides a practical means to determine the emetogenic potential of individual chemotherapy agents and combination regimens during the 24 hours after administration. This system can serve as a framework for the development of antiemetic guidelines.
Collapse
Affiliation(s)
- P J Hesketh
- St Elizabeth's Medical Center, Boston, MA 02135, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
45
|
Grote TH, Pineda LF, Figlin RA, Pendergrass KB, Hesketh PJ, Karlan BY, Reeves JA, Porter LL, Benedict CR, Hahne WF. Oral dolasetron mesylate in patients receiving moderately emetogenic platinum-containing chemotherapy. Oral Dolasetron Dose Response Study Group. Cancer J Sci Am 1997; 3:45-51. [PMID: 9072308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE This double-blind, dose-response study was conducted to assess the safety and efficacy of four oral doses of dolasetron mesylate for preventing acute emesis in cancer patients receiving their first course of moderately emetogenic platinum-containing chemotherapy. PATIENTS AND METHODS Patients were randomized to receive a single oral dose of 25, 50, 100, or 200 mg dolasetron 30 minutes before receiving IV carboplatin (275-400 mg/m2)- or cisplatin (20-50 mg/m2)-containing chemotherapy, then monitored for nausea and vomiting for 24 hours. RESULTS Three hundred seven cancer patients from 32 sites completed the study. There was a statistically significant dose response across the four doses for complete response (no emetic episodes or rescue medication): 44.7%, 71.3%, 73.2%, and 82.5% for the 25, 50, 100, or 200 mg doses of dolasetron, respectively. Patients' nausea severity and patient satisfaction visual analogue scale scores also showed a statistically significant trend with dose. All doses of dolasetron were well tolerated. The most common adverse events were headache (17.6%) and dizziness (2.0%). DISCUSSION This study demonstrates the safety and antiemetic efficacy of oral dolasetron mesylate in patients receiving moderately emetogenic platinum-containing chemotherapy with the highest antiemetic activity observed at 200 mg.
Collapse
Affiliation(s)
- T H Grote
- Forsyth Hematology-Oncology Association, Winston-Salem, NC 27103, USA
| | | | | | | | | | | | | | | | | | | |
Collapse
|
46
|
Abstract
Chemotherapy-induced emesis has a major adverse impact on patients undergoing therapy for various malignancies, and this has led to considerable research in this field. Most investigative efforts have concentrated on the acute phase of emesis that occurs within the first 24 hours after chemotherapy, and significant strides forward have been made with this problem. Better control of acute emesis with newer agents such as the serotonin 5-HT3 receptor antagonists has focused increasing attention on a second phase of nausea and vomiting, known as delayed emesis, which occurs more than 24 hours after chemotherapy. This delayed phase is often not as well controlled with the antiemetics that have proven effective in acute emesis, and contributes to the distress associated with emetogenic chemotherapy. Most of the available data on delayed emesis are based on studies with cisplatin-based regimens, with much less understanding of delayed nausea and vomiting induced by non-cisplatin-based chemotherapy. Nevertheless, it is evident that the patterns of delayed emesis associated with cisplatin and non-cisplatin chemotherapy have distinct differences. The control of delayed emesis, especially following cisplatin, remains a therapeutic challenge. Contributing to the lack of progress has been the absence of an experimental model to help in elucidating the pathophysiology of delayed emesis and in the evaluation of new therapeutic approaches. The combination of metoclopramide and dexamethasone, although superior to placebo in randomised trials, provides only moderate control of delayed emesis following high-dose cisplatin. The 5-HT3 receptor antagonists that are effective in the prevention of acute emesis with cisplatin have failed to make a major impact on the delayed phase. When combined with dexamethasone, these agents provide no additional benefit to that achieved using dexamethasone alone or dexamethasone combined with metoclopramide. With non-cisplatin chemotherapy, corticosteroids and 5-HT3 receptor antagonists are the most useful agents. Efforts are ongoing to identify more effective treatments for delayed emesis. One novel approach involves the blockade of substance P binding to neurokinin-1 (NK1) receptors. This article reviews what is currently known about chemotherapy-induced delayed emesis, with a focus on treatment strategies.
Collapse
Affiliation(s)
- R Tavorath
- Section of Medical Oncology, St Elizabeth's Medical Center, Boston, Massachusetts, USA
| | | |
Collapse
|
47
|
Abstract
Recent data suggest that breast cancer in elderly women does not present as more advanced disease, nor is survival significantly inferior to that in younger women. Unfortunately, until recently, older women have been excluded from clinical trials that have determined survival benefit in both screening and treatment modalities. Unless co-morbid conditions adversely affect one's life expectancy or tolerance to therapy, older women should be treated with standard surgical procedures (including breast conservation, if so desired) for early-stage disease, as outcome is comparable to that in younger patients. Adjuvant tamoxifen therapy has proven survival benefit in women over 70 years of age with estrogen receptor-positive tumors and should be considered in all women with tumors greater than 1 cm in size. Older women may experience more chemotherapy-related toxicities. However, for those with a significant risk of recurrence due to tumor size or lymph node status, chemotherapy can be safely administered when factors such as age-related decline in creatinine clearance and co-morbid conditions are considered. Hormonal therapy (tamoxifen) is usually the first-line treatment option over chemotherapy for metastatic disease in the elderly unless the patient has an estrogen receptor-negative tumor, visceral-dominant disease, or significant disease-related symptoms. In the latter settings, chemotherapy can provide improved or more rapid response proportions but does not affect long-term survival.
Collapse
Affiliation(s)
- T M Law
- St. Elizabeth's Medical Center, Boston, USA
| | | | | | | | | | | |
Collapse
|
48
|
Hesketh PJ, Gandara DR, Hesketh AM, Facada A, Perez EA, Webber LM, Martin LA, Cramer MB, Hahne WF. Dose-ranging evaluation of the antiemetic efficacy of intravenous dolasetron in patients receiving chemotherapy with doxorubicin or cyclophosphamide. Support Care Cancer 1996; 4:141-6. [PMID: 8673351 DOI: 10.1007/bf01845763] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Selective 5-HT3 antagonists have proven to be safe and effective for the prevention of chemotherapy-induced nausea and vomiting. Dolasetron is a new highly selective addition to this class of antiemetics that has been shown to have significant antiemetic activity in patients receiving cisplatin-containing regimens. This pilot study was designed to evaluate the antiemetic efficacy of dolasetron in cancer patients receiving doxorubicin and/or cyclophosphamide. This study used an open-label, non-randomized design to evaluate the efficacy and safety of intravenous dolasetron in the prevention of emesis in patients receiving doxorubicin (25-75 mg/m2) and/or cyclophosphamide (400-1200 mg/m2). Sixty-nine patients received a single, intravenous dose of dolasetron over 15-20 min beginning 30 min prior to the start of chemotherapy. Dose levels of dolasetron studied were: 0.3, 0.6, 1.2, 1.8 and 2.4 mg/kg. Patients were monitored for emesis, nausea and adverse events for 24h after the start of chemotherapy. Overall, 61% of patients experienced complete control of emesis. No significant trend towards increased antiemetic efficacy (P = 0.076) or nausea control with increasing dolasetron dose was noted, although the power to detect significant differences was limited by the small number of patients on the 0.3-mg/kg and 2.4-mg/kg dose levels. Age, gender, and type of chemotherapy were significant predictors of complete antiemetic control. Adverse events were generally mild and included headache, chills, lightheadedness, fever, diarrhea, dizziness, and asymptomatic prolongation of ECG intervals. Intravenous dolasetron is safe and effective in the prevention of emesis induced by doxorubicin and/or cyclophosphamide.
Collapse
Affiliation(s)
- P J Hesketh
- Section of Medical Oncology, St. Elizabeth's Medical Center, Boston, MA 02135, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
49
|
Hesketh PJ, Beck T, Uhlenhopp M, Kris MG, Hainsworth JD, Harker WG, Cohen JR, Lester E, Kessler JF, Griffen D. Adjusting the dose of intravenous ondansetron plus dexamethasone to the emetogenic potential of the chemotherapy regimen. J Clin Oncol 1995; 13:2117-22. [PMID: 7636556 DOI: 10.1200/jco.1995.13.8.2117] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
PURPOSE This pilot, open-label study evaluates the antiemetic efficacy and safety of a single 20-mg intravenous (IV) dose of dexamethasone combined with a single IV dose of ondansetron (32, 24, or 8 mg) in patients receiving highly emetogenic (HE), moderately high emetogenic (MHE), or moderately emetogenic (ME) chemotherapy, respectively. PATIENTS AND METHODS One hundred forty-six patients received a single 20-mg IV dose of dexamethasone over 15 minutes beginning 45 minutes before chemotherapy and either a single 32-, 24-, or 8-mg IV dose of ondansetron over 15 minutes beginning 30 minutes before chemotherapy. Patients were evaluated for emetic episodes, extent of nausea, and adverse events for 24 hours after chemotherapy. RESULTS Complete response (no emetic episodes) was noted in 72% (95% confidence interval [CI], 60% to 84%), 88% (95% CI, 79% to 97%), and 77% (95% CI, 63% to 92%) of patients in the HE, MHE, and ME categories, respectively. The proportion of patients who experienced no nausea on the posttreatment assessment was 51% (95% CI, 37% to 64%), 69% (95% CI, 56% to 81%), and 47% (95% CI, 29% to 65%), respectively. The antiemetic regimens were all well tolerated. The proportion of patients with any drug-related adverse events did not vary across the three study groups despite the range of ondansetron doses and variety of chemotherapy regimens. Mild headache was noted in 28% of patients. Other adverse events, all of which were noted in fewer than 10% of patients, included lightheadedness, fatigue, dizziness, and constipation. CONCLUSION A single IV dose of either 8, 24, or 32 mg of ondansetron combined with a single 20-mg IV dose of dexamethasone resulted in good control of acute emesis across a wide spectrum of chemotherapy regimens. Nausea control proved somewhat more difficult, with approximately 50% of patients in the HE and ME emetogenic categories experiencing some degree of nausea. The results of our pilot study suggest that adjusting the dose of ondansetron to the intrinsic emetogenicity of the chemotherapy regimen permits a more efficient use of ondansetron while maintaining good antiemetic control. Such an approach appears worthy of further investigation.
Collapse
|
50
|
DeSilva MS, Zhang Y, Hesketh PJ, Maclay GJ, Gendel SM, Stetter JR. Impedance based sensing of the specific binding reaction between Staphylococcus enterotoxin B and its antibody on an ultra-thin platinum film. Biosens Bioelectron 1995; 10:675-82. [PMID: 7576435 DOI: 10.1016/0956-5663(95)96958-2] [Citation(s) in RCA: 77] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Immunobiosensing techniques to measure specific antigen-antibody binding reactions are important in the development of biosensor applications in biotechnology, in vitro diagnosis, medicine and food technology. An immunobiosensor was constructed to measure the specific binding reaction between Staphylococcus enterotoxin B (SEB) and anti-SEB antibodies. The biosensor comprised an anti-SEB bioactive layer covalently immobilized on an ultra-thin platinum (Pt) film sputtered onto a 100 nm thick silicon dioxide layer on a silicon chip. The Pt film was discontinuous with a normal thickness of 25 A. The impedance of the Pt film decreased during the binding of the anti-SEB to SEB in phosphate buffered saline (PBS) at room temperature. The impedance decreases were irreversible in PBS before saturation of the specific binding sites. When saturated, the impedance at 100 Hz was 14% of the value obtained for the fresh anti-SEB layer in PBS. The magnitude of the impedance (Z) decrease followed a simple relationship with SEB concentration in the range between 0.389 and 10.70 ng/ml SEB. The specificity of the biosensor was demonstrated by showing that no irreversible impedance decreases occurred when the sensor was exposed to 100 ng/ml kappa-casein, or alpha-lactalbumin, in PBS.
Collapse
Affiliation(s)
- M S DeSilva
- Department of Chemistry, Illinois Institute of Technology, Chicago 60616, USA
| | | | | | | | | | | |
Collapse
|