Survey ranking of emetogenic control in children receiving chemotherapy

Purpose: To determine the effect of standard antiemetic treatment in childr en receiving various combination chemotherapy regimens. Methods: A validated nausea/vomiting survey was administered to 78 patients receiving 13 different emetogenic chemotherapy regimens. Patients received antiemetic prophylaxis with ondansetron (0.3 mg/kg/day) alone for moderate ly emetogenic chemotherapy regimens or ondansetron (0.45 mg/kg/day) and met hylprednisolone (4 mg/kg/day) for severely emetogenic chemotherapy regimens . A total of 324 different courses of chemotherapy were surveyed. Nausea an d vomiting severity, duration, number of emetic episodes, appetite, daily a ctivity interference, and rates of both complete and good antiemetic protec tion were determined for each chemotherapy protocol. Differences between ge nders and ages were analyzed. Results: Chemotherapy combinations containing platinum compounds were found to be highly emetogenic and nauseating despite antiemetic therapy with ond ansetron plus a corticosteroid. In addition, complete antiemetic protection for the combination of vincristine, cyclophosphamide, and dactinomycin was poor. For most of the severely emetogenic chemotherapy protocols, patients experienced good protection from nausea and vomiting less than 60% of the time, despite the use of ondansetron plus methylprednisolone. Significant d ifferences were found in rates of residual nausea and vomiting and failure of antiemetic protection among the severely emetogenic chemotherapy protoco ls despite identical antiemetic therapy. Good protection fates were higher for moderately emetogenic chemotherapy treated with ondansetron alone. Conclusions: The currently recommended prophylactic therapy for pediatric p atients receiving severely emetogenic chemotherapy:fails to provide protect ion for many patients receiving commonly administered chemotherapy regimens and for most pediatric patients receiving platinum-containing chemotherapy combinations. New and refined antiemetic strategies are needed to improve efficacy in the pediatric population.