DEXAMETHASONE, GRANISETRON, OR BOTH FOR THE PREVENTION OF NAUSEA AND VOMITING DURING CHEMOTHERAPY FOR CANCER

Background. Serotonin-receptor antagonists seem to be as effective as corticosteroids in preventing emesis induced by moderately emetogenic antineoplastic agents. We compared the antiemetic effect of a combinat ion of granisetron and dexamethasone with that of granisetron or dexam ethasone administered alone. Methods. From December 1992 to January 19 94, 428 consecutive patients who were to receive moderately emetogenic chemotherapy for the first time (600 to 1000 mg of cyclophosphamide p er square meter of body-surface area, greater than or equal to 50 mg o f doxorubicin per square meter, greater than or equal to 75 mg of epir ubicin per square meter, or greater than or equal to 300 mg of carbopl atin per square meter, alone or in some combination) were enrolled in a double-blind, randomized, multicenter study evaluating the efficacy and toxicity of three antiemetic regimens. The following antiemetic re gimens were used: 8 mg of dexamethasone given intravenously before che motherapy plus 4 mg given orally immediately before chemotherapy and t hen every six hours for a total of four doses, 3 mg of granisetron giv en intravenously be fore chemotherapy, or a combination of granisetron and dexamethasone given in the doses used for the single-drug regimen s. Results. We evaluated 408 patients (136 receiving dexamethasone, 13 7 receiving granisetron, and 135 receiving both drugs), In the first 2 4 hours after chemotherapy, complete protection from vomiting and comp lete protection from nausea were achieved in 70.6 and 55.1 percent, re spectively, of the patients receiving dexamethasone, in 72.3 and 48.2 percent of those receiving granisetron, and in 92.6 and 71.9 percent o f those receiving granisetron combined with dexamethasone (P<0.001 for all comparisons). Patients who received granisetron alone had less pr otection from delayed vomiting and nausea than those who received dexa methasone alone or the two drugs combined. All the regimens were equal ly well tolerated. Conclusion. Granisetron combined with dexamethasone was the most effective regimen for the prevention of emesis induced b y moderately emetogenic chemotherapy.