Department of Surgery, Kangbuk Samsung Hospital, Korea
Corresponding Author:
Hungdai Kim ,Tel: +82-2-2001-2137, Fax: +82-2-2001-2131, Email: hungdai.kim@samsung.com
Received: May 15, 2006; Accepted: June 15, 2006.
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ABSTRACT
Chemotherapy-induced nausea and vomiting is a major debilitating side effect of oncology treatment. The most significant progress was realized during the decade of the 1990's. During that time, selective antagonists of the type three 5-hydroxytryptamine receptor were first introduced and quickly became the cornorstone of antiemetic management. In addition, several trials confirmed the value of combining corticosteroids with the 5-HT3 antagonists. Among the first generation 5-HT3 antagonist, granisetron shows substantially longer mean plasma elimanation half-life values of 9hours compared to 4.7hours of ondansetron. Combined use of granisetron and dexamathasone provide more complete and prolonged protection against acute stage CINV, but limited effect against delayed CINV. Recent studies suggest that the second generation 5-HT3 receptor antagonist palonosetron and neurokinin-1 receptor antagonist aprepitant may have some efficacy in controlling delayed CINV compared to the first generation 5-HT3 receptor antagonists. Recently, National Comprehensive Cancer Network and Multinational Association of Supportive Care in Cancer suggested clinical guideline; pre-chemotherapy use of aprepitant, 5-HT3 receptor antagonist, and dexamethasone, post-chemotherapy use of aprepitant and dexamethasone, post-chemotherapy use of dexamethasone only for moderately-emetogenic chemotherapy regimen. Antipsychotic drug olanzapine showed improved effect against CINV when additionally used with dexamethasone and granisetron.
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