MANAGEMENT OF CHEMOTHERAPY-INDUCED EMESIS - WHAT IS THE STANDARD AFTER 20 YEARS OF CLINICAL RESEARCH

Background: The knowledge of the importance, the physiopathological me chanisms, and the management of the chemotherapy-induced emesis has in creased exponentially during the last 20 years. High-dosage metoclopra mide (MCP) therapy has been introduced in the eighties and serotonine type-3 receptor antagonists (5-HT3 antagonists) have been used since t he late eighties and early nineties. Due to both classes of substances the results of the antiemetic therapies have improved drastically. Af ter 20 years of intensive clinical research it seems to be appropriate to come to an intermediate conclusion. Method: With the aid of an ove rview and a new analysis of the literature published on this topic so far, the current state of research is shown (including the fields in w hich further improvement will be necessary), and suggestions are made, wherever it seemed possible, to attain the ''gold standard'' in antie metic therapy. Results and Conclusions: In connection with all highly or very highly emetogenic chemotherapies, an antiemetic prophylaxis sh ould be initiated on the day therapy, especially when using platinum o r most of the cyclophosphamide-based regimes for cancer treatment. The recommended prophylaxis consists of a combination of 5-HT3 antagonist s with a corticosteroid. To combat the so-called delayed emesis on the days following therapy, all patients should undergo an oral corticoid therapy, possibly in combination with MCP (especially platinum-therap y patients), less frequently with 5-HT3 antagonists. With these means of prophylaxis emesis can be prevented/avoided completely in most pati ents, and nausea can at least be reduced. It is sufficient to administ er a single dose of 5-HT3 antagonists prior to chemotherapy. For ondan setron and granisetron, the best documented substances within this cla ss of drugs, 8 mg (ondansteron) and 3 mg (granisetron) are considered standard dosages. Among the corticoids, most data have been accumulate d for dexamethasone. A standard dose of 10 to 20 mg can be administere d prior to chemotherapy. Right after and especially on the days follow ing chemotherapy higher dosages seem to be indicated. Prospect: Furthe r therapy improvements, especially concerning emesis and nausea on the days following chemotherapy, are necessary and are currently object o f clinical research.