Prospective evaluation of the incidence of delayed nausea and vomiting in patients with colorectal cancer receiving oxaliplatin-based chemotherapy

Support Care Cancer. 2012 May;20(5):1043-7. doi: 10.1007/s00520-011-1180-2. Epub 2011 May 9.

Abstract

Purpose: This study sought to prospectively determine the frequency of delayed nausea and vomiting with oxaliplatin-based chemotherapy following day 1 prophylaxis with a 5-HT-(3) receptor antagonist and dexamethasone.

Methods: Patients with colon cancer, ≥ age 18, with a performance status ≤ 2, receiving oxaliplatin (85-100 mg/m(2)) as part of a standard folinic acid, 5-fluorouracil, oxaliplatin regimen for the first time were eligible. All patients received a 5-HT(3) receptor antagonist and dexamethasone 20 mg on day 1 prior to oxaliplatin. No routine prophylaxis for delayed emesis was given. Antiemetic outcome was recorded in patient-completed diaries for the 120-h study period following oxaliplatin administration. Primary endpoint was frequency of delayed (24-120 h) emesis (vomiting/retching).

Results: Forty-one patients were enrolled and 39 are evaluable. Median age was 70 (34-85) and the female/male ratio was 20:19. Four patients (10%) experienced vomiting or retching during the delayed period. One patient vomited during the first 24 h after oxaliplatin. The overall (120 h) no emesis rate was 87% (34/39). Twenty-one patients (54%) developed delayed nausea. Nine patients had moderate or severe nausea. Eighteen patients (46%) took rescue antiemetics during the delayed period. Delayed and overall complete response (no emesis or use of rescue antiemetics) rates were 54% and 49%, respectively.

Conclusions: The use of a 5-HT(3) antagonist and dexamethasone prior to oxaliplatin results in excellent control of nausea and vomiting (CR-90%) during the 24 h after chemotherapy. However, without further antiemetic treatment, complete response in the delayed period decreased to 54%. This study supports the need for routine antiemetic prophylaxis for delayed nausea and vomiting following oxaliplatin-based chemotherapy.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Antiemetics / therapeutic use*
  • Antineoplastic Agents, Phytogenic / adverse effects*
  • Antineoplastic Agents, Phytogenic / therapeutic use
  • Colorectal Neoplasms / drug therapy
  • Dexamethasone / therapeutic use
  • Female
  • Fluorouracil / administration & dosage
  • Humans
  • Incidence
  • Leucovorin / administration & dosage
  • Male
  • Middle Aged
  • Nausea / chemically induced
  • Nausea / epidemiology*
  • Nausea / prevention & control
  • Organoplatinum Compounds / administration & dosage
  • Oxaliplatin
  • Prospective Studies
  • Serotonin 5-HT3 Receptor Antagonists / therapeutic use
  • Time Factors
  • Vomiting / chemically induced
  • Vomiting / epidemiology*
  • Vomiting / prevention & control

Substances

  • Antiemetics
  • Antineoplastic Agents, Phytogenic
  • Organoplatinum Compounds
  • Serotonin 5-HT3 Receptor Antagonists
  • Oxaliplatin
  • Dexamethasone
  • Leucovorin
  • Fluorouracil