tropisetron and Abdominal-Neoplasms

Dexamethasone (20 mg) or its equivalent in combination with 5-HT3 antagonists appears to be the gold-standard dose for antiemetic prophylaxis. Additional to concerns about the use of corticosteroids with respect to enhanced tumour growth or impaired killing of the tumour cells, there is evidence that high-dosage dexamethasone impairs the control of delayed nausea and emesis, whereas lower doses appear more beneficial. To come closer to the most adequate dose, we started a prospective, single-blind, randomized trial investigating additional dosage of 8 or 20 mg dexamethasone to tropisetron (Navoban), a 5-HT3 receptor antagonist, in cis-platinum-containing chemotherapy. After an interim analysis of 121 courses of chemotherapy in 69 patients, we have been unable to detect major differences between both treatment alternatives. High-dose dexamethasone (20 mg) had no advantage over medium-dose dexamethasone with respect to objective and subjective parameters of acute and delayed nausea and vomiting. In relation to concerns about the use of corticosteroids in non-haematological cancer chemotherapy, we suggest that 8 mg or its equivalent should be used in combination with 5-HT3 antagonists until further research proves otherwise.

Topics: Abdominal Neoplasms; Adult; Aged; Antiemetics; Antineoplastic Agents; Carcinoma; Cisplatin; Dexamethasone; Dose-Response Relationship, Drug; Fallopian Tube Neoplasms; Female; Humans; Indoles; Infusions, Intravenous; Male; Middle Aged; Nausea; Ovarian Neoplasms; Prospective Studies; Serotonin Antagonists; Single-Blind Method; Tropisetron; Vomiting, Anticipatory

Topics: Abdominal Neoplasms; Aged; Anaphylaxis; Antineoplastic Agents; Carboplatin; Chemotherapy, Adjuvant; Cimetidine; Clemastine; Combined Modality Therapy; Desensitization, Immunologic; Dexamethasone; Drug Hypersensitivity; Drug Therapy, Combination; Female; Humans; Indoles; Infusions, Intravenous; Lung Neoplasms; Ovarian Neoplasms; Premedication; Tropisetron

A prospective trial was performed to better assess the risk of nausea and vomiting and the rescue value of tropisetron (TRO), a 5-HT3 receptor antagonist, in 88 patients undergoing fractionated radiotherapy to the abdomen or to large supradiaphragmatic fields and failing a first anti-emetic trial with metoclopramide (MET). Nausea was graded 0 (absent), 1 (mild), 2 (moderate) and 3 (severe). Nausea requiring anti-emetics (> or = grade 2) was present in 64% of the patients. MET was able to control nausea (< or = grade 1) in 26 of 58 patients (45%) who developed > or = grade 2 nausea during radiation treatment (2 patients vomiting without nausea included). 34 patients required TRO, and 31 experienced immediate relief. However, nausea (> or = grade 2) recurred in 7 patients from 1 to 3 weeks after starting TRO. Sex, age, field type and field size (cm2) did not influence the incidence and severity of nausea and vomiting. Only 24/88 patients vomited after starting radiotherapy. MET helped to eliminate emesis in one third of these patients. TRO helped to control vomiting in 73% of the salvaged patients. Constipation was observed in 8 patients on TRO and was a reason to stop the medication in 4 cases.

Topics: Abdominal Neoplasms; Adolescent; Adult; Aged; Aged, 80 and over; Antiemetics; Child; Female; Humans; Indoles; Male; Metoclopramide; Middle Aged; Nausea; Prospective Studies; Tropisetron; Vomiting