ANTI-EMESIS WITH CANCER-CHEMOTHERAPY

Advances in supportive care have been among the most influential chang es in cancer treatments over the past few years. Effective anti-emetic therapy has markedly reduced suffering due to emesis and has allowed most chemotherapy to be delivered on an outpatient basis. Carefully de signed studies have combined knowledge of clinical aspects of chemothe rapy treatment with relevant neuropharmacological considerations. This has permitted the continued development of new agents and combination regimens, resulting in better emetic control with fewer side-effects and optimal patient and staff convenience. Today, the most extensively used anti-emetic agents for patients receiving moderately to severely emetogenic chemotherapy are the 5-hydroxytryptamine (5-HT3) receptor antagonists. Currently available agents in this therapeutic class incl ude ondansetron, granisetron, and tropisetron; dolasetron, another mem ber of this class, is available in the U.K. and is now approvable in t he U.S.A. Use of the best proven regimens prevents both acute and dela yed emesis in most patients. In patients receiving cisplatin, 75-85% a chieve complete control of acute emesis and 50-75% have complete contr ol of delayed emesis. In patients receiving moderately emetogenic chem otherapy, complete control of acute emesis is achieved by 90% of patie nts and complete control of delayed emesis by 80-95% of patients. The most effective and convenient regimens for acute emesis employ a combi nation of serotonin antagonists with corticosteroids, single-dose sche dules, the lowest effective doses and, most recently, oral administrat ion. Further improvement of emetic control will require more widesprea d adherence to the best established regimens and identification of oth er pharmacological pathways. (C) 1997 Published by Elsevier Science Lt d.