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13 The most significant among the predictive factors is the failure to obtain complete protection against acute emesis.
Most clinical experience of effective vomiting control, efficacy in delayed and acute emesis has been reported with methylprednisolone and dexamethasone.
This finding provides a strong rationale to combine 5HT3 antagonists and NK1 antagonists to optimise acute emesis control.
The rate of complete control of acute emesis was 49% for the phase II trial and 60% for the phase III trial.
To prevent acute emesis, antiemetic treatment should be administered just before chemotherapy and patients should be protected for up to 24 hours following chemotherapy initiation.
Although L-758,298 also appeared to reduce acute emesis post-cisplatin, there was a numerical advantage in acute protection for ondansetron.
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In the acute-emesis phase, 93% of the patients in the L-754,030 groups and 67% of those receiving granisetron plus dexamethasone plus placebo had no vomiting (P<0.001).
41 A recent, large phase III clinical trial which included 1114 patients receiving highly emetogenic chemotherapy, showed that palonosetron and dexamethasone are noninferior to granisetron and dexamethasone in antiemetic control of acute phase emesis, and better than granisetron and dexamethasone in the delayed phase.
Although with extended regimens of daily oral use the distinction between acute and delayed emesis is less clear, cumulative emesis must be considered, as some of the newer agents may only become emetogenic after a week or more of continuous administration [ 4, 5].
Palonosetron is a 5-HT3 receptor antagonist that has demonstrated superiority in preventing both acute and delayed emesis when compared to older first generation 5-HT3 receptor antagonists.
Good control of acute and delayed emesis may result in a lower incidence of ANV.
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