Antiemetic prophylaxis with ondansetron and methylprednisolone vs metoclopramide and methylprednisolone in mild and moderately emetogenic chemotherapy

The purpose of the present study was to examine whether its is possible to successfully replace ondansetron (OND) with metoclopramide (MCP) in patient s examined to moderately emetogenic chemotherapy who did not experience sev ere nausea and vomiting while undergoing OND treatment during their first c hemotherapy cycle. After switching to MPC, patients continued with this dru g for three cycles, provided that they had adequate control of nausea and v omiting. Otherwise, they were switched back to OND. There were 76 patients, 60 women and 16 men, whose median age was 56 (mean 58) years. Karnofsky pe rformance status score was 100 in 18 patients, 90 in 23, and 80 in 11 patie nts. No patient had previous chemotherapy Thirty-four patients had breast c ancer and received fluorouracil 500 mg/m(2) epirubicin 100 500 mg/m(2), and cyclophosphamide 500 mg/m(2). Twelve patients had small cell lung cancer a nd received carboplatin 400 mg/m(2) + etoposide 120 mg/m(2) X 3 days. Twent y patients with ovarian cancer received carboplatin 350 mg/m(2) and cycloph osphamide 500 mg/m(2). Ten patients had cancer of unknown primary and recei ved carboplatin 400 mg/m(2), epirubicin 60 mg/m(2), and etoposide 120 mg/m( 2) X 3 days. The OND schedule consisted of methylprednisolone 40 mg intrave nous bolus followed by OND 8 mg in a 15-min infusion before chemotherapy fo llowed by OM) 4 mg orally X 3 on the same and the next 2 days. Patients who did not experience nausea and vomiting with OND continued with an MCP sche dule consisting of methylprednisolone 40 mg bolus followed by MCP 2 mg/kg i n a 15-min infusion before chemotherapy, followed by MCP (20 mg X 4 on the day of therapy and the next 2 days after). Patients who failed with MCP or OND) continued with OND. Considering our results as a whole, the intensity of nausea does not appear to influence the results of Gralla's scale. The r esults of Gralla's scale do not appear to be affected by the analysis of th e antiemetic results and nausea on the next 2 days following chemotherapy a dministration. Overall patients received 145 cycles with OND and 159 cycles with MCP. Of the 76 patients receiving OND-based antiemetic regimen during the first cycle, 13 (21%) experienced severe vomiting (Grade 2, 3) and the remaining 63 (79%) had mild or no vomiting (Grade 0, 1). Patients with Gra de 0, 1 vomiting (63, 83%) continued with MCP in the second cycle. The fina l number of patients who failed on MCP after 4 cycles of chemotherapy incre ased to 33 (43 %); 43 (57 %) were able to complete chemotherapy with MCP. H eadache occurred in 15 (10 %) cycles with OND and 8 (5 %) with MCP. Flushin g was noted in 12 (8 %), and constipation occurred in 43 (30 %) of OND cycl es, and extrapyramidal manifestations occurred in 3 (5 %) of patients recei ving MCP. Diarrhea was noted in 3 (2 %) of cycles with OND and in 28 (18 %) with MCP. The cost ratio between MCP and OND wets 1:14. If we administered OND only in patients who needed it, the overall cost decreased to 44 %. Fo llowing the strategy applied in the present study, the cost decreased to 47 %. (C) U.S. Cancer-Pain Relief Committee, 1999.