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  • 1
    Electronic Resource
    Electronic Resource
    Springer
    Supportive care in cancer 5 (1997), S. 12-16 
    ISSN: 1433-7339
    Keywords: Guidelines ; Antiemetics ; Chemotherapy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Major breakthroughs in the treatment of chemotherapy-induced emesis have come through the use of selective 5-HT3 receptor antagonists in combination with corticosteroids. This combination can be considered standard for most but not all commonly used chemotherapeutic agents. Delayedonset emesis remains a problem, particularly for patients receiving high-dose cisplatin. There is debate over the value of using selective 5-HT3 receptor antagonists beyond the first 24 h. Clinical trials have not settled this uncertainty, although it seems likely that they add only modestly to the effect of corticosteroids. For both the acute and delayed phases, dopamine receptor antagonists may add to the effectiveness of antiemetic therapy. This article outlines a strategy for initial antiemetic therapy and the rationale for the recommendations.
    Type of Medium: Electronic Resource
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  • 2
    ISSN: 1433-7339
    Keywords: Antiemetic ; 5-HT3 receptor antagonist ; Dexamethasone ; Efficacy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The object of the study was to determine whether dexamethasone improved the efficacy of the serotonin receptor (5-HT3) antagonist granisetron in controlling acute (within 24 h) emesis in cancer patients receiving high-dose cisplatin chemotherapy and to ascertain whether continuation of granisetron after 24 h reduces the occurrence of delayed emesis. This randomised, double-blind, multicentre, three-arm study was conducted at 21 medical centres. A group of 292 nausea- and emcsis-free patients with cancer, who had never had chemotherapy and were scheduled to receive at least 50 mg/m2 cisplatin, were given 3 mg granisetron i.v. in a 15-min infusion with or without 10 mg dexamethasone i.v. completed 5 min prior to high-dose cisplatin and 1 mg granisetron p.o. at +6 h and +12 h. Primary study end-points were control of emesis and nausea. Patients completed a self-report diary every 6 h for the first 24 h. At the end of the 24-h period, the patients who received dexamethasone had a significantly higher complete protection rate from emesis (64% compared to 39%) than those who received no steroid. Similarly, the dexamethasone-treated group had a significantly higher complete plus partial (0–2 emetic episodes) protection rate (84% compared to 64%). This study shows that dexamethasone markedly enhances the antiemetic efficacy of granisetron for acute-onset emesis in high-dose cisplatin chemotherapy.
    Type of Medium: Electronic Resource
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  • 3
    Electronic Resource
    Electronic Resource
    Springer
    Supportive care in cancer 5 (1996), S. 12-16 
    ISSN: 1433-7339
    Keywords: Key words Guidelines ; Antiemetics ; Chemotherapy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Major breakthroughs in the treatment of chemotherapy-induced emesis have come through the use of selective 5-HT3 receptor antagonists in combination with corticosteroids. This combination can be considered standard for most but not all commonly used chemotherapeutic agents. Delayed-onset emesis remains a problem, particularly for patients receiving high-dose cisplatin. There is debate over the value of using selective 5-HT3 receptor antagonists beyond the first 24 h. Clinical trials have not settled this uncertainty, although it seems likely that they add only modestly to the effect of corticosteroids. For both the acute and delayed phases, dopamine receptor antagonists may add to the effectiveness of antiemetic therapy. This article outlines a strategy for initial antiemetic therapy and the rationale for the recommendations.
    Type of Medium: Electronic Resource
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  • 4
    ISSN: 1433-7339
    Keywords: Key words Chemotherapy induced emesis ; Serotonin receptors ; Ondansetron ; Granisetron ; Dolesetron ; Tropisetron
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Selective antagonists to the Type 3 serotonin receptor (5HT3) in combination with corticosteroids are now considered the standard of care for the prevention of emesis from moderately to highly emetogenic chemotherapy. Here we address issues of optimal dose, schedule and route of administration of four currently available selectable 5HT3 antagonists. This paper utilizes an evidence based medicine approach to the literature regarding this class of drugs, emphasizing the results large, randomized, controlled trials to make formal recommendations concerning optimal use of this important new class of anti-emetic agents. We conclude that for each drug there is a plateau in therapeutic efficacy at a definable dose level above which further dose escalation does not improve outcome. Furthermore, a single dose is as effective as multiple doses or continuous infusion, and finally, emerging data demonstrate that the oral route is equally efficacious as the intravenous route of administration, even with highly emetogenic chemotherapy.
    Type of Medium: Electronic Resource
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  • 5
    ISSN: 1433-7339
    Keywords: Key words Quality of life ; Chemotherapy ; Cancer ; Nausea ; Vomiting
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  The purpose was to measure the effects of postchemotherapy nausea and vomiting (PCNV) on health-related quality of life (HQL) in patients receiving either moderately or highly emetogenic chemotherapy. The study sample consisted of 832 chemotherapy-naive patients with cancer who received either moderately or highly emetogenic chemotherapy as part of multicenter trials of new antiemetics. The patients completed the self-report European Organization for Research and Cancer (EORTC) core Quality of Life Questionnaire (QLQ-C30) before chemotherapy (baseline) and 1 week (day 8) and 2–4 weeks after chemotherapy. They also completed a self-report nausea and vomiting (NV) diary for 5–7 days after chemotherapy. To determine the effects of PCNV on HQL, the change in scores between the baseline and day 8 HQL assessments was calculated for each domain and symptom in the QLQ-C30 and compared in four subgroups of patients: those with both nausea and vomiting, those with nausea but no vomiting, those with no nausea but with vomiting, and those with neither nausea nor vomiting. The group with both nausea and vomiting showed statistically significantly worse physical, cognitive and social functioning, global quality of life, fatigue, anorexia, insomnia and dyspnea as compared to the group with neither nausea nor vomiting (0.0001〈P〈0.05). Patients with only nausea but no vomiting tended to have less worsening in functioning and symptoms than those having both nausea and vomiting. Increased severity of vomiting (〉2 episodes) was associated with worsening of only global quality of life and anorexia as compared with 1–2 episodes of vomiting (0.0001〈P〈0.01). By 2–4 weeks after chemotherapy all HQL scores had either returned to their baseline levels or were better than baseline. PCNV adversely affects several quality-of-life domains, but patients with only nausea experience less disruption than do those with both nausea and vomiting. Patients with 1–2 episodes of vomiting experience almost the same degree of disruption of HQL as do patients with more than 2 episodes of vomiting.
    Type of Medium: Electronic Resource
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  • 6
    ISSN: 1573-7217
    Keywords: breast cancer ; folinic acid ; 5FU ; metastatic
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Standard combination chemotherapy for metastatic breast cancer produces response rates between 30–60% with limited impact on survival. We undertook a phase II trial to determine the activity of 5 fluorouracil (5FU) and folinic acid (FA) in patients with measurable metastatic or recurrent breast cancer who had received no prior chemotherapy. Patients meeting the eligibility criteria received 5FU 370 mg/m2/day and FA 200 mg/m2/day for 5 days repeated every 28 days, toxicity allowing. Response defined by standard criteria was assessed every 8 weeks and toxicity according to WHO criteria was determined on every course. Thirty-three patients were entered on trial. Thirty-two patients were evaluable for response and 33 for toxicity. The dose limiting toxicity was stomatitis with 7/32, 19/32, and 5/32 patients experiencing grade 1, 2, and 3 toxicity. Grades 1 and 2 diarrhea occurred in 17/32 and 11/32 patients respectively. Myelosuppression was not significant. Two complete and 11 partial responses were observed. The overall response rate was 41% (95% CI, 24–58%). Responses were seen in soft tissue and visceral sites. Patients who had received adjuvant chemotherapy more than 6 months prior to receiving 5FU and FA responded also. Six of 29 patients receiving standard combination chemotherapy as second line treatment responded subsequently. We concluded: 1) 5FU and FA is an active combination in the treatment of breast cancer warranting further evaluation in combination with other drugs; 2) the dose-limiting toxicity of stomatitis is tolerable; 3) patients receiving 5FU and FA as first line therapy can respond to conventional combination chemotherapy as second line treatment.
    Type of Medium: Electronic Resource
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