ALBUQUERQUE--Oncologists and pharmacists at the University of
New Mexico initially turned to reduced-dose ondansetron (Zofran)
for their pediatric leukemia patients for sheer expediency--most
of the children were receiving their chemotherapy as outpatients
and were only in the clinic for about 4 hours per treatment.
This made it impossible to give the recommended intravenous ondansetron
dosage of 0.15 mg/kg every 4 hours for three doses during the
"We settled on two doses and demonstrated efficacy for quite
a few chemotherapy protocols, with a very good side effect profile,"
Mark T. Holdsworth, PharmD, assistant professor, College of Pharmacy,
University of New Mexico, told Oncology News International in
The New Mexico investigators evaluated 255 courses of emetogenic
chemotherapy in 16 pediatric outpatients with ALL. No antiemetic
therapy was administered with 149 courses (primarily because,
before ondansetron became available, patients often refused antiemetic
therapy due to lack of perceived benefit). Two doses of IV ondansetron,
0.15 g/kg, were given with 106 courses, one dose prior to and
one dose immediately following each course.
Fourteen patients received an intensive ALL regimen with both
IV and intrathecal chemotherapy, and two patients received a low-risk
ALL regimen with only intrathecal treatments.
Intrathecal therapy consisted of methotrexate, hydrocortisone,
and cytarabine. Patients on intensive regimens also received sequential
IV courses of cyclophosphamide (Cytoxan, Neosar), daunorubicin
(Cerubidine), carmustine (BiCNU), and a combination of cytarabine
and etoposide (VePesid).
Ondansetron provided complete protection against nausea and vomiting
for more than 60% of the courses of carmustine and etoposide/cytarabine,
and complete protection against vomiting for more than 55% of
the courses of cyclophosphamide, Dr. Holdsworth said. These agents
or combinations represent three of the four most emetogenic treatments
examined in the study.