palonosetron and Thoracic-Neoplasms

Radiation-induced nausea and vomiting is a common problem for cancer patients. The emetogenic potential of radiation depends greatly on the location of the radiation field, the size of the radiation field, and the fractionation scheme. Radiation fields can be categorized as having high, moderate, low, or minimal emetogenic risk, and treatment differs accordingly. The National Comprehensive Cancer Network, the Multinational Association of Supportive Care in Cancer, and the American Society of Clinical Oncology publish clinical practice guidelines addressing the issue of radiation-induced nausea and vomiting. This article reviews the treatment recommendations for each category of radiation-induced nausea and vomiting from these national and international guideline committees and provides the rationale for these recommendations.

Topics: Abdominal Neoplasms; Dexamethasone; Dose Fractionation, Radiation; Head and Neck Neoplasms; Humans; Isoquinolines; Nausea; Palonosetron; Practice Guidelines as Topic; Quinuclidines; Radiotherapy; Serotonin Antagonists; Thoracic Neoplasms; Vomiting

The three-drug combination of a 5-hydroxytryptamine type 3 receptor antagonist, a neurokinin 1 receptor antagonist and dexamethasone is recommended for patients receiving highly emetogenic chemotherapy. However, standard antiemetic therapy is not completely effective in all patients.. We conducted an open-label, single-center, single-arm Phase II study to evaluate the efficacy of olanzapine in combination with standard antiemetic therapy in preventing chemotherapy-induced nausea and vomiting in patients with thoracic malignancy receiving their first cycle of cisplatin-based chemotherapy. Patients received 5 mg oral olanzapine on Days 1-5 in combination with standard antiemetic therapy. The primary endpoint was complete response (no vomiting and no use of rescue therapy) during the overall Phase (0-120 h post-chemotherapy).. Twenty-three men and seven women were enrolled between May and October 2015. The median age was 64 years (range: 36-75 years). The most common chemotherapy regimen was 75 mg/m2 cisplatin and 500 mg/m2 pemetrexed, which was administered to 14 patients. Complete response rates in acute (0-24 h post-chemotherapy), delayed (24-120 h post-chemotherapy) and overall phases were 100%, 83% and 83% (90% confidence interval: 70-92%; 95% confidence interval: 66-93%), respectively. There were no Grade 3 or Grade 4 adverse events. Although four patients (13%) experienced Grade 1 somnolence, no patients discontinued olanzapine.. The addition of 5 mg oral olanzapine to standard antiemetic therapy demonstrates promising efficacy in preventing cisplatin-based chemotherapy-induced nausea and vomiting and an acceptable safety profile in patients with thoracic malignancy.

Topics: Adult; Aged; Antiemetics; Antineoplastic Agents; Aprepitant; Benzodiazepines; Cisplatin; Dexamethasone; Female; Humans; Isoquinolines; Male; Middle Aged; Morpholines; Nausea; Olanzapine; Palonosetron; Quinuclidines; Thoracic Neoplasms; Vomiting