CONSENSUS PROPOSAL FOR 5HT(3) ANTAGONISTS IN THE PREVENTION OF ACUTE EMESIS RELATED TO HIGHLY EMETOGENIC CHEMOTHERAPY - DOSE, SCHEDULE, ANDROUTE OF ADMINISTRATION

Selective antagonists to the Type 3 serotonin receptor (5HT(3)) in com bination with corticosteroids are now considered the standard of care for the prevention of emesis from moderately to highly emetogenic chem otherapy. Here we address issues of optimal dose, schedule and route o f administration of four currently available selectable 5HT(3) antagon ists. This paper utilizes an evidence based medicine approach to the l iterature regarding this class of drugs, emphasizing the results large , randomized, controlled trials to make formal recommendations concern ing optimal use of this important new class of anti-emetic agents. We conclude that for each drug there is a plateau in therapeutic efficacy at a definable dose level above which further dose escalation does no t improve outcome. Furthermore, a single dose is as effective as multi ple doses or continuous infusion, and finally, emerging data demonstra te that the oral route is equally efficacious as the intravenous route of administration, even with highly emetogenic chemotherapy.