Guidelines for Complications of Cancer Treatment Vol VIII Part B

supported by a meta-analysis, which examined 11 randomizedtrials that used 5-HT 3receptor antagonists with moderatelyemetic chemotherapy. It demonstrated that the risk of acuteemesis was decreased with the use of 5-HT 3receptorantagonists (odds ratio = 0.47; 95% CI, 0.39 to 0.58) and thatthe risk was further reduced when drugs in this class werecombined with dexamethasone. (Level I , A)Similarly for the prevention of delayed emesis, dexamethasoneas a single agent is recommended as demonstrated by the Italiangroup in their phase three trial. This trial demonstrated thatdexamethasone was superior to placebo in decreasing delayedemesis (87% v 77%, respectively; P < .02), that dexamethasoneplus 5-HT 3antagonist was not superior to dexamethasone alone(92% v 87%, respectively), and also that the combination wasassociated with more constipation. (Level I, A)Low Emetic RiskIn this group, Dexamethasone, as a single agent isrecommended for both acute and delayed emesis. A metaanalysisof 32 RCTs involving 5,613 patients demonstratedthat dexamethasone was superior to placebo or no treatmentfor complete protection from acute emesis (odds ratio = 2.22;95% CI, 1.89 to 2.60) and for complete protection from delayedemesis (odds ratio = 2.04; 95% CI, 1.63 to 2.56). (Level I, A)Management of Anticipatory Nausea andVomiting Good control of emesis in previous chemotherapy doses. Behavior therapy with systemic desensitization. (LevelV, D) Drugs like alprazolam (0.5 – 2mg po qid) or olanzapine.399