Progress in reducing nausea and emesis. Comparisons of ondansetron (zofran), granisetron (kytril), and tropisetron (navoban)

Abstract

Background. Nausea and vomiting are the most distressing side effects associated with the administration of chemotherapy for neoplastic diseases. Nausea, in particular, often had been ignored in studies of chemotherapy side effects. Recently, progress has been made in the control of chemotherapy‐induced nausea and vomiting, due, in part, to a better understanding of the physiologic mechanisms involved. Methods. This paper reviews recent advances in the control of emesis, focusing on pharmacologic treatments. Results. The efficacy and safety of the serotonin (5‐HT3) receptor antagonists granisetron, ondansetron, and tropisetron in the control of acute and delayed emesis and emesis induced by repeat‐cycle chemotherapy are summarized. Although differences in study design and definitions of response criteria have made it difficult to compare the studies that have evaluated these three agents, the overall body of literature supports several clinical findings. Conclusions. (1) The 5HT3 antiemetic agents have been shown to be clinically more effective in the control of nausea and emesis than previously used agents. (2) No one of the three has demonstrated consistently greater efficacy. (3) Efficacy appears to be more pronounced for cisplatin‐containing regimens than for moderate or less emetogenic chemotherapy regimens. (4) Effectiveness of the 5HT3 agents appears to be less for delayed nausea and emesis than for acute symptoms. Potential control of anticipatory nausea and emesis has not been investigated. (5) Control over nausea appears to be significantly less than control over emesis. In the studies in which it has been measured, nausea control remains incomplete for approximately half the patients given 5HT3 agents. (6) The efficacy of the agents appears to diminish across repeated days and, perhaps, across repeated chemotherapy cycles. (7) The addition of a steroid such as dexamethasone increases the efficacy of both 5HT3 and other antiemetic agents. This effect also seems to apply to delayed nausea and emesis Cancer 1995;76:343–57.

Role of classical conditioning in learning gastrointestinal symptoms

“…Nausea is accompanied by changes in autonomic nervous system activity, particularly parasympathetic activity, diminished gastric tone, reduced peristalsis and retrograde peristalsis, and retrograde duodenal peristalsis." Vomiting is the "forceful emptying of the gastric contents through the sustained action of abdominal muscles and the opening of the gastric cardia [1] ." Nausea and vomiting occur under a variety of conditions, Paul Enck, Dr, Professor, Series Editor www.wjgnet.com such as in cancer chemotherapy, after vestibulary stimulation (motion sickness), or during pregnancy.…”

Major clinical research advances in gynecologic cancer 2009

“…For example, data from University of Rochester Cancer Center Community Clinical Oncology Program Research Base study showed that 77% of patients with highly emetogenic therapies experienced delayed nausea and 20-30% of patients suffered anticipatory nausea or vomiting. 41,42 Therefore, it is necessary to develop new modalities to control postchemotherapy nausea and vomiting. In the 2009 ASCO annual meeting, the results of RCT testing the efficacy of ginger in alleviating the post-chemotherapy nausea were presented.…”

The broad‐spectrum anti‐emetic activity of AS‐8112, a novel dopamine D2, D3 and 5‐HT3 receptors antagonist

“…The discovery of the 5-HT 3 receptor antagonists has dramatically improved the treatment of emesis induced by anti-cancer therapy (Aapro, 1991;Morrow et al, 1995). Their major bene®cial eects were observed in the acute phase of chemotherapy-induced emesis in animal models (Bermudez et al, 1988;Higgins et al, 1989;Rudd & Naylor, 1996) and in humans (Morrow et al, 1995).…”

“…Their major bene®cial eects were observed in the acute phase of chemotherapy-induced emesis in animal models (Bermudez et al, 1988;Higgins et al, 1989;Rudd & Naylor, 1996) and in humans (Morrow et al, 1995). However, 5-HT 3 receptor antagonists such as ondansetron and granisetron failed to control the delayed nausea and vomiting associated with chemotherapy (De Mulder et al, 1990;Butcher, 1993).…”