Nausea and vomiting may be the limiting factors in anticancer chemotherapy and these unpleasant side effects can be so severe that some patients may delay or stop the chemotherapy.
At Yonsei Cancer Center, sixty-nine patients undergoing systemic chemotherapy with cisplatin were studied in a prospective, randomized fashion to compare the antiemetic efficacy of a combination regimen consisted of dexamethasone and metoclopramide with that of each dexamethasone and metoclopramide alone.
Dexamethdsone was given by intravenous injection at a does of 10 mg for total 3 doses, given 30 minutes before Cisplatin, then 2 and 4 hours afterward. Metoclopramide was given as an iv at a dose of 20mg with same intervals as dexamethasone. Combination regimen of dexamethasone and metoclopramide was given with same doses and intervals as mentioned above.
Patients treated with the combination regimen(average number of vomitings: 2) had significantly fewer vomiting episodes, compared with that of metoclopramide (average number of vomitings: 6, p<0. 005) or dexamethasone (average number of vomitings: 3.8, P<0. 01) alone group.
Patients with poor performance status(H₃, average number of vomitings: 8.3) showed significantly more vomiting episodes than that of better performance status(H₁, average number of vomitings: 2.9. P<0.005).
Side effects such as sedation(10%). diarrhea(13%) and general weakness(32%) were observed in combination therapy group, but reversible and acceptable.
We concluded that combinations of intravenous metcclopramide plus dexamethasone are effective in controlling cisplatin induced emesis, but showed somewhat reduced efficacy in patients with poor performance status.
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