Use of 5-HT3 receptor antagonists to prevent nausea and emesis caused by chemotherapy for patients with breast carcinoma in community practice settings

BACKGROUND. Although 5-HT3 receptor antagonists are clinically more effecti ve in controlling emesis, particularly that caused by high dose cisplatin, than previously available agents, they appear to be less effective against nausea. This report focuses on the effectiveness of these agents against na usea and emesis in patients receiving two moderately emetogenic combination chemotherapy regimens as treatment for breast carcinoma in community pract ice settings. METHODS. Six hundred ninety-two breast carcinoma patients (688 female, 4 ma le; mean age, 51 years) enrolled in a nonrandomized study completed the Mor row Assessment of Nausea and Emesis (MANE) following 4 consecutive chemothe rapy treatments. The frequency, duration, and severity of postchemotherapy nausea (PN) and postchemotherapy emesis (PE) were compared by type of antie metic (5-HT3 receptor antagonist vs. other) and chemotherapy regimen (cyclo phosphamide and doxorubicin with or without 5-fluorouracil [CA/CAF] vs, cyc lophosphamide, methrotrexate, and 5-fluorouracil [CMF]). RESULTS. Within each regimen, the mean duration of PN was significantly lon ger for patients who received a 5-HT3 receptor antagonist than for those wh o were not given an antiemetic of that type (CA: 40.3 hours vs. 29.6 hours, P < 0.05; CMF: 37.6 hours vs. 30.2 hours, P < 0.05). There were no signifi cant differences in the frequency or severity of nausea or in the frequency , severity, or duration of emesis by type of antiemetic for patients receiv ing Either regimen. CONCLUSIONS. The results of this observational study suggest that 5-HT3 rec eptor antagonists are no more effective than other commonly used medication s in controlling postchemotherapy nausea and emesis in women with breast ca rcinoma who are treated with moderately emetogenic chemotherapy in communit y practice settings. In fact, they may be associated with significant prolo ngation of the course of postchemotherapy nausea. Cancer 1999;86:64-71, (C) 1999 American Cancer Society.