Ondansetron + dexamethasone vs metoclopramide + dexamethasone + diphenhydramine in prevention of cisplatin-induced emesis

F. Roila, M. Tonato, E. Ballatori, D. Paes, A. Del Favero, C. Basurto, S. Bracarda, E. Corgna, M. Picciafuoco, L. Patoia, G. Favalii, R. Garbelli, U. A. Bianchi, G. Scarfone, C. Ferraris, M. C. Bolis, F. Cognetti, A. Cercato, F. Buzzi

Research output: Contribution to journalArticlepeer-review

Abstract

Ondansetron, a selective serotonin-receptor antagonist, is an effective antiemetic for patients receiving high-dose cisplatin chemotherapy. However, no comparison has been made between a combination of a serotonin antagonist and dexamethasone, which also has antiemetic properties, with currently available antiemetic regimens. 289 consecutive cancer patients receiving cisplatin chemotherapy (≥ 50 mg/m2) were randomised to receive one of the following intravenous antiemetic regimens: ondansetron 0.15 mg/kg, before and after cisplatin, + dexamethasone 20 mg before cisplatin (treatment A) or metoclopramide 3 mg/kg, before and after cisplatin, + dexamethasone + diphenhydramine 50 mg before cisplatin (treatment B). From day 2 to day 4, all patients received oral metoclopramide and intramuscular dexamethasone. 267 patients (136 receiving treatment A and 131 treatment B) were available for analysis. Complete protection against emesis was achieved in 107 (78.7%) and 78 (59.5%) patients, respectively (p < 0.002). Complete protection was also significantly superior for treatment A on day 2 (83.9% vs 68.0%; p < 0.006). Complete protection from acute nausea (first 24 h) was achieved in 105 patients (77.2%) with treatment A and in 86 (65.6%) with treatment B (p < 0.051); complete protection from nausea and emesis was achieved in 94 (69.1%) patients and 66 (50.4%), respectively (p < 0.003). Patients receiving treatment B noted significantly more sedation than patients receiving treatment A (11.8% vs 2.1%; p < 0.005). Extrapyramidal reactions were present only with treatment B (2.7%). Ondansetron + dexamethasone is more effective and better tolerated than metoclopramide + dexamethasone + diphenhydramine in the prevention of cisplatin-induced nausea and emesis.

Original languageEnglish
Pages (from-to)96-99
Number of pages4
JournalLancet
Volume340
Issue number8811
DOIs
Publication statusPublished - 1992

ASJC Scopus subject areas

  • Medicine(all)

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