TREATMENT OF CHEMOTHERAPY-INDUCED EMESIS IN THE 1990S - IMPACT OF THE5-HT3 RECEPTOR ANTAGONISTS

Considerable progress has been made in the development of means to lim it nausea and vomiting arising from cancer chemotherapy. A number of k ey conceptual advances in the last decade have been critically importa nt. These include recognition of the value of combination antiemetic t herapy, identification of important patient- and treatment-related fac tors predictive of emesis, and appreciation of the importance of serot onin (5-HT) in the pathophysiology of emesis and the value of selectiv e antagonists of the type-3 serotonin receptor. Comparative trials of the 5-HT3 receptor antagonists and classic antiemetic agents have help ed define optimal antiemetic approaches in a number of settings. A com bination of a 5-HT3 antagonist and dexamethasone is the treatment of c hoice for patients receiving single- and multiple-day cisplatin. The 5 -HT3 antagonists are also effective agents with noncisplatin chemother apy. Clear-cut superiority to clasic antiemetics such as dexamethasone has not been consistently demonstrated, however. Results with the 5-H T3 antagonists in cisplatin-induced delayed emesis have been disappoin ting to date. The results of ongoing prospective trials should define their role more clearly. At present a combination of metoclopramide an d dexamethasone is the treatment of choice in this setting. Results of trials comparing 5-HT3 antagonists are beginning to emerge. Available information suggests no clinically relevant differences in antiemetic efficacy between these agents. Many questions regarding the optimal u se of the 5-HT3 antagonists and their integration into clinical practi ce remain unanswered and are the appropriate focus for additional stud y.