Effectiveness of antiemetic drugs in prevention of chemotherapy (CT) induced acute emesis

Author(s): De Angelis V, G Ciccarese, S Mammoliti, S Mazzotta, G Pacilio, P Malacame, G Comella, I Carreca, V Fosser, FM Gioffre, G Amunni, A Contu, Del Favero A Abstract: Efficacy obtained by treatment in clinical trials can be different from that achieved in daily practice (effectiveness), due to differences in the characteristics of population studied and/or of dose-schedule of drugs utilized. No data on this problem, at least for antiemetic treatment of CT-induced emesis, are available. This prompted us to carry out a prospective drug utilization study at 33 Italian ontological centers. Results of antiemetic effectiveness during the first 24 hrs in 1220 patients (pts) receiving one-day CT are reported. Response was evaluated by interviewing pts by phone after 24 hrs from CT. Overall complete protection from vomiting/nausea was obtained in 83.9%/58.9% of pts. In particular, complete protection from vomiting/nausea was obtained in 75.7%/61.4% of 140 pts receiving cisplatin (CDDP)-based CT, in 81.8%/52.6% of 742 pts receiving moderately emetogenic CT (MEC) (94 pts carboplatin, 184 epirubicin, 105 doxorubicin, 304 cyclophosphamide and 55 mitoxantrone) and in 91.7%/71.6% of 338 pts receiving low emetogenic CT (i.e., gemcitabine, vincristine, vinblastine, vinorelbine, methotrexate, mitomycin C, bleomycin, etoposide, teniposide, etc.). Complete protection from vomiting/nausea in pts receiving CDDP was 79.4%/68.2% if they received the standard combination of corticosteroids plus a 5-HT3 receptor antagonist and 63.6%/39.4% if not, while in pts receiving MEC it was 84.7%/79.7% and 56.4%/49.8%, respectively. The rate of protection from emesis achieved in patients monitored in this study is not different from that obtained in those enrolled in clinical trials despite the fact that a great variety of doses and schedules of the various antiemetics (in particular corticosteroids) was observed.