LISBON, Portugal--Combining granisetron (Kytril), a 5-HT3 antagonist,
with high and repeated doses of dexamethasone yields superior
protection against nausea and vomiting than either agent alone
in cancer patients receiving moderately emetogenic antineoplastic
agents, Dr. Maurizio Tonato reported on behalf of the Italian
Group for Antiemetic Research.
This 13-month trial recruited more than 400 consecutive patients
in 27 Italian centers who had been treated with one or more of
the following cytotoxic drugs: cyclophosphamide, 600 to 1,000
mg/m²; doxorubicin,equal to or more than 50 mg/m²; epirubicin,
equal to or more than 75 mg/m²; or carboplatin, equal to
or more than 300 mg/m², said Dr. Tonato at the congress of
the European Society of Medical Oncology.
On their first day of chemotherapy, these subjects were randomized
to receive either granisetron, 3 mg IV 20 minutes prior to the
start of chemotherapy, or dexamethasone, 8 mg IV 15 minutes before
chemotherapy, and four oral doses of 4 mg each, or the same dosing
schedules of the two drugs in combination.
More than 90% of patients receiving combination antiemetic therapy
experienced no vomiting whatsoever during the first 24 hours after
chemotherapy, compared with roughly 70% of subjects treated with
either single-drug regimen.
Both dexamethasone alone and in combination with granisetron were
superior to granisetron alone in controlling delayed emesis, with
80% of patients remaining free of vomiting and 50% free of nausea
on the second to the fifth day following chemotherapy when patients
received no antiemetic prophylaxis.
All three regimens were equally well tolerated. The most common
complaints were constipation and hot flushes in patients randomized
to the combination regimen, and pyrosis in those receiving dexamethasone