The antiemetic efficacy of granisetron plus dexamethasone, haloperidol and loracepam in breast cancer patients treated with high-dose chemotherapy with peripheral blood stem-cell support

Abstract

There has recently been a marked trend to increasing dose intensity in cancer chemotherapy, with or without peripheral blood stem-cell support, which has been associated with a higher frequency of nausea and vomiting. Antiemetic treatment in this setting has not been extensively analysed. From October 1995 to January 1997, prevention of emesis with granisetron 3 mg/12 h i.v., dexamethasone 12 mg/24 h i.v., haloperidol 0.5 mg/12 h p.o., and loracepam I mg/24 h p.o. was instituted in 30 breast cancer patients treated with high-dose chemotherapy (a 4-day intravenous continuous infusion of cyclophosphamide 1500 mg/m2 per day, thio-TEPA 125 mg/m2 per day and carboplatin 200 mg/m2 per day).A total of 30% of the patients (9/30) obtained complete or major protection on the 4 days of chemotherapy treatment (96.7% (29/30) on day 1, 86.7% (26/30) on day 2, 70% (21/30) on day 3, and 50% (15/30) on day 4). On the days following chemotherapy, 46.7% (14/30) presented fewer than two emetic episodes on day 5, 70% (21/30) on day 6, 83.4% (25/30) on day 7 and, 93.3% (28/30) on day 8. This energic antiemetic combination treatment has hardly any effect in the prevention of emesis, providing complete or major protection of 30% for the 4 days of chemotherapy treatment. Further investigation aimed at improving antiemetic treatment results is necessary.

The NK-1 receptor-antagonist aprepitant in high-dose chemotherapy (highdose melphalan and high-dose T-ICE: paclitaxel, ifosfamide, carboplatin, etoposide): efficacy and safety of a triple antiemetic combination

“…So far, no valid data has been published with regard to the emetogenic potential of the cryo-preservatives, in which stem cells have been suspended. These results are not suitably comparable-in the study by Climent et al, 15 the antiemetics were given on the transplantation day on an as needed basis, whereas all patients in our study received the protocol mandated antiemetic therapy. Furthermore, in our study it is not possible to distinguish whether the high CR rates on the day of the stem cell reinfusion are related to a sufficient antiemetic prophylaxis or a possible low emetogenic potential of the cryo-preservatives.…”

“…Although the study results are difficult to compare (different end point, therapeutic regimen and broad variation in patient populations), our results showed better antiemetic control with 83% CR in the acute phase and 70% CR in the delayed phase, especially when considering our strict response criterias. Climent et al 15 presented results of a study in 30 patients with breast cancer, who received HDC with CY 1500 mg/ m 2 /day, thiotepa 125 mg/m 2 /day and carboplatin 200 mg/ m 2 /day all over 4 days. The CINV prophylaxis regime consisted of granisetron (3 mg/12 h i.v.…”

Antiemetic therapy for multiple-day chemotherapy and high-dose chemotherapy with stem cell transplant: review and consensus statement

“…Only 30% (nine of 30) obtained complete or major protection during the 4-day course, with best results on days 1-2 [6]. By contrast, Abbott, et al, at M.D.…”

Efficacy and Safety of Aprepitant in Allogeneic Hematopoietic Stem Cell Transplantation

“…[2][3][4] Although the combination of dexamethasone plus a 5-HT 3 receptor antagonist is often used prior to HSCT, vomiting is not controlled in as many as 80-93% of patients. [5][6][7][8][9][10][11][12][13] Since the neurokinin-1 receptor antagonist aprepitant was approved, the use of triple combination antiemetic therapy (i.e., dexamethasone, 5-HT 3 receptor antagonist, and aprepitant) has resulted in further improvements in the control of CINV in non-HSCT patients with solid tumors who are treated with moderate to highly emetogenic chemotherapy. [14][15][16] In addition, aprepitant has been recently reported to prevent CINV associated with high-dose preparative regimens followed by HSCT.…”

“…Dexamethasone in combination with a 5‐hydroxytryptamine 3 (5‐HT 3 ) receptor antagonist represents the standard of care in CINV associated with high‐dose conditioning regimens for hematopoietic stem cell transplantation (HSCT) . Although the combination of dexamethasone plus a 5‐HT 3 receptor antagonist is often used prior to HSCT, vomiting is not controlled in as many as 80–93% of patients …”