Anti-emesis with cancer chemotherapy

Advances in supportive care have been among the most influential changes in cancer treatments over the past few years. Effective anti-emetic therapy has markedly reduced suffering due to emesis and has allowed most chemotherapy to be delivered on an outpatient basis. Carefully designed studies have combined knowledge of clinical aspects of chemotherapy treatment with relevant neuropharmacological considerations. This has permitted the continued development of new agents and combination regimens, resulting in better emetic control with fewer side-effects and optimal patient and staff convenience. Today, the most extensively used anti-emetic agents for patients receiving moderately to severely emetogenic chemotherapy are the 5- hydroxytryptamine (5-HT₃) receptor antagonists. Currently available agents in this therapeutic class include ondansetron, granisetron, and tropisetron; dolasetron, another member of this class, is available in the U.K. and is now approvable in the U.S.A. Use of the best proven regimens prevents both acute and delayed emesis in most patients. In patients receiving cisplatin, 75-85% achieve complete control of acute emesis and 50-75% have complete control of delayed emesis. In patients receiving moderately emetogenic chemotherapy, complete control of acute emesis is achieved by 90% of patients and complete control of delayed emesis by 80-95% of patients. The most effective and convenient regimens for acute emesis employ a combination of serotonin antagonists with corticosteroids, single-dose schedules, the lowest effective doses and, most recently, oral administration. Further improvement of emetic control will require more widespread adherence to the best established regimens and identification of other pharmacological pathways.