Delayed Nausea After Chemotherapy: 3 Questions Answered
Hi. This is Dr. Kathy Miller with Indiana University here, with a quick Medscape Oncology video blog. I was just looking through one of the most recent issues of the Journal of Clinical Oncology, and I came across an important supportive care article that I want to make sure you all see.

This is a study conducted by the University of Rochester Community Clinical Oncology Program (CCOP), looking at several questions related to optimal treatment of delayed nausea and vomiting. This problem is not as devastating and as frequent as it used to be. We now have a much better way of controlling acute nausea and vomiting, but for some patients, delayed nausea and vomiting, particularly with highly emetogenic regimens, is still a major issue.

This trial used an elegant, randomized design looking at 4 different treatment strategies. It was designed to answer several questions independently. First, there was a direct comparison between 2 agents, palonosetron and granisetron, used primarily for their benefit in acute nausea and vomiting. The second question looked at more extended dexamethasone, comparing dexamethasone given only on day 1 vs dexamethasone continuing on days 2 and 3. The third question looked at regular use of prochlorperazine on days 2 and 3, or the use of aprepitant.

This was a large effort, enrolling about 250 patients in each arm who had a variety of tumor types. With standard nausea and vomiting measures and a variety of highly emetogenic chemotherapy agents, the results are fascinating and instructive. First, it didn't make any difference what was prescribed for acute nausea and vomiting. Palonosetron or granisetron had similar effects on delayed nausea and vomiting. Extended dexamethasone (something we have commonly used in clinical practice but without really robust data) was clearly helpful and reduced delayed nausea and vomiting.

Regularly scheduled use of a much less expensive agent -- aprepitant -- worked comparably, with no significant benefit from the more expensive, newer agents. I find these results instructive for our clinical practice. They are potentially very cost-saving, something of which we need to be increasingly aware. This is a fabulous example of an important clinical question addressed in the community where most of our patients are treated, giving us even greater confidence in the results.

Take a look at this article and join me in congratulating the University of Rochester CCOP on their excellent work.