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Incidence of delayed nausea and vomiting in patients with colorectal cancer receiving irinotecan-based chemotherapy

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Abstract

Purpose

This study sought to prospectively determine the frequency of delayed nausea and vomiting with irinotecan-based chemotherapy following day 1 prophylaxis with a 5-HT3 receptor antagonist and dexamethasone.

Methods

Patients with colorectal cancer aged ≥ 18 years with ECOG performance status ≤ 2 receiving irinotecan alone, combined with cetuximab or as part of a standard folinic acid, 5-flourouracil, irinotecan (FOLFIRI) regimen for the first time were eligible. All patients received a 5-HT3 receptor antagonist and dexamethasone 8 mg on day 1 prior to irinotecan. No routine prophylaxis for delayed emesis was given. Antiemetic outcome was recorded in patient-completed diaries for the 120-h study period after irinotecan administration. Primary endpoint was frequency of delayed (24–120 h) emesis.

Results

Forty-four patients were enrolled, and all are evaluable. The median age was 61 (39–79) years; the male–female ratio was 37:7. Four patients (9%) experienced vomiting or retching during the delayed period. Three patients (7%) vomited during the first 24 h after irinotecan. The overall no emesis rate was 89% (39/44). Fifteen patients (34%) experienced delayed nausea (mild in 11 patients, moderate in four patients). Six patients (14%) took rescue antiemetics during the delayed period. Delayed and overall complete response (no emesis or use of rescue antiemetics) rates were 82% and 77% respectively.

Conclusions

The use of a 5-HT3 antagonist and dexamethasone prior to irinotecan results in excellent control of nausea and vomiting (CR 86%) during the 24 h after chemotherapy. Without further antiemetic treatment, most patients (82%) will not experience delayed emesis or require rescue antiemetics. Routine prophylaxis for delayed emesis following irinotecan does not appear to be warranted.

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References

  1. Hesketh PJ (2008) Chemotherapy-induced nausea and vomiting. N Engl J Med 358(23):2482–2494

    Article  PubMed  CAS  Google Scholar 

  2. Hesketh PJ, Kris MG, Grunberg SM et al (1997) Proposal for classifying the acute emetogenicity of cancer chemotherapy. J Clin Oncol 15:103–9

    PubMed  CAS  Google Scholar 

  3. Kris MG, Hesketh PJ, Somerfield MR et al (2006) American Society of Clinical Oncology. American Society of Clinical Oncology guideline for antiemetics in oncology: update 2006. J Clin Oncol 24(18):2932–2947

    Article  PubMed  CAS  Google Scholar 

  4. Roila F, Herrstedt J, Aapro M et al (2010) Guideline update for MASCC and ESMO in the prevention of chemotherapy- and radiotherapy-induced nausea and vomiting: results of the Perugia consensus conference. Ann Oncol 21(Suppl 5):v232–43

    Article  PubMed  Google Scholar 

  5. Tavorath R, Hesketh PJ (1996) Drug treatment of chemotherapy-induced delayed emesis. Drugs 52(5):639–648

    Article  PubMed  CAS  Google Scholar 

  6. Kris MG, Gralla RJ, Clark RA et al (1985) Incidence, course and severity of delayed nausea and vomiting following the administration of high-dose cisplatin. J Clin Oncol 3:1379–84

    PubMed  CAS  Google Scholar 

  7. Martin M, Diaz-Rubio E, Sanchez A et al (1990) The natural course of emesis after carboplatin treatment. Acta Oncologica 29:593–595

    Article  PubMed  CAS  Google Scholar 

  8. Hesketh PJ, Sanz-Altamira P, Bushey J, Hesketh AM (2011) Prospective evaluation of the incidence of delayed nausea and vomiting in patients with colorectal cancer receiving oxaliplatin-based chemotherapy. Support Care Cancer (Epub ahead of print) May 9, 2011

  9. Fukuoka M, Niitani H, Suzuki A et al (1992) A phase II study of CPT-11, a new derivative of camptothecin, for previously untreated non-small-cell lung cancer. J Clin Oncol 10:16–20

    PubMed  CAS  Google Scholar 

  10. Shimada Y, Yoshino M, Wakui A et al (1993) Phase II study of CPT-11, a new camptothecin derivative in metastatic colorectal cancer. J Clin Oncol 11:909–13

    PubMed  CAS  Google Scholar 

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Acknowledgements

The authors acknowledge the expert assistance of Wendy Loeser and Ann Marie Hesketh (St. Elizabeth’s Medical Center, Boston, MA), Julie Bushey and Pedro Sanz-Altamira (Holy Family Hospital, Methuen, MA) and Tamara Ilich and Tina Kocan (Institute for Radiology and Oncology of Serbia) in patient recruitment and data retrieval for this clinical trial. The authors also gratefully acknowledge Merck for providing a grant in support of this study.

Conflicts of interest

P.J.H is a consultant for Merck, Eisai and Helsinn.

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Authors and Affiliations

  1. Lahey Clinic Medical Center, Burlington, MA, USA

    Paul J. Hesketh

  2. Institute for Oncology and Radiology of Serbia, Belgrade, Serbia

    Snezana M. Bosnjak & Vlada Nikolic

  3. Medical Oncology Centre of Rosebank, Johannesburg, South Africa

    Bernardo Rapoport

Authors
  1. Paul J. Hesketh
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  2. Snezana M. Bosnjak
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  3. Vlada Nikolic
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  4. Bernardo Rapoport
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Corresponding author

Correspondence to Paul J. Hesketh.

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Hesketh, P.J., Bosnjak, S.M., Nikolic, V. et al. Incidence of delayed nausea and vomiting in patients with colorectal cancer receiving irinotecan-based chemotherapy. Support Care Cancer 19, 2063–2066 (2011). https://doi.org/10.1007/s00520-011-1286-6

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  • DOI: https://doi.org/10.1007/s00520-011-1286-6

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