ORAL COMBINATION ANTIEMETICS IN PATIENTS WITH SMALL-CELL LUNG-CANCER RECEIVING CISPLATIN OR CYCLOPHOSPHAMIDE PLUS DOXORUBICIN

Background. Intravenous antiemetic combinations containing a 5-HT3 rec eptor antagonist (like metoclopramide, ondansetron, or granisetron) wi th dexamethasone have become the standard therapy for the treatment of acute chemotherapy-induced vomiting. Intravenous antiemetics, however , can be more costly and take more time to prepare and deliver, and th erefore are not preferred for home, outpatient, or office use. The obj ective of this study was to determine the antiemetic activity and safe ty of the oral combination antiemetic regimen of metoclopramide, dexam ethasone, and diphenhydramine in patients with small cell lung cancer receiving standard outpatient chemotherapy programs. Methods. Fifty-tw o patients receiving initial cisplatin (60 mg/m(2)) of cyclophosphamid e (600-1500 mg/m(2)) plus doxorubicin (30-45 mg/m(2)) received an oral regimen of metoclopramide (3 mg/kg X 2 then 2 mg/kg X 2 or 4 doses), dexamethasone (20 mg) and diphenhydramine (50 mg X 2 or 3 doses) (oral MDD), beginning 30 minutes before chemotherapy. Results, Vomiting was prevented in 15 of 21 (76%) patients (95% confidence interval [CI], 5 3%-92%) receiving cisplatin and 21 of 31 (71%) individuals (95% CI, 52 %-86%) given cyclophosphamide plus doxorubicin. Adverse effects were m ild and transient and included sedation, loose stools, akathisia, and hiccoughs. Conclusions, The oral MDD antiemetic regimen prevented acut e emesis in 73% of the patients entered and was well tolerated in this population of patients with small cell lung cancer.