The purpose of the present study was to examine whether its is possible
to successfully replace ondansetron (OND) with metoclopramide (MCP) in
patients examined to moderately emetogenic chemotherapy who did not
experience severe nausea and vomiting while undergoing OND treatment
during their first chemotherapy cycle. After switching to MPC, patients
continued with this drug for three cycles, provided that they had
adequate control of nausea and vomiting. Otherwise, they were switched
back to OND. There were 76 patients, 60 women and 16 men, whose median
age was 56 (mean 58) years. Karnofsky performance status score was 100
in 18 patients, 90 in 23, and 80 in 11 patients. No patient had previous
chemotherapy Thirty-four patients had breast cancer and received
fluorouracil 500 mg/m(2) epirubicin 100 500 mg/m(2), and
cyclophosphamide 500 mg/m(2). Twelve patients had small cell lung cancer
and received carboplatin 400 mg/m(2) + etoposide 120 mg/m(2) X 3 days.
Twenty patients with ovarian cancer received carboplatin 350 mg/m(2) and
cyclophosphamide 500 mg/m(2). Ten patients had cancer of unknown primary
and received carboplatin 400 mg/m(2), epirubicin 60 mg/m(2), and
etoposide 120 mg/m(2) X 3 days. The OND schedule consisted of
methylprednisolone 40 mg intravenous bolus followed by OND 8 mg in a
15-min infusion before chemotherapy followed by OM) 4 mg orally X 3 on
the same and the next 2 days. Patients who did not experience nausea and
vomiting with OND continued with an MCP schedule consisting of
methylprednisolone 40 mg bolus followed by MCP 2 mg/kg in a 15-min
infusion before chemotherapy, followed by MCP (20 mg X 4 on the day of
therapy and the next 2 days after). Patients who failed with MCP or OND)
continued with OND. Considering our results as a whole, the intensity of
nausea does not appear to influence the results of Gralla’s scale. The
results of Gralla’s scale do not appear to be affected by the analysis
of the antiemetic results and nausea on the next 2 days following
chemotherapy administration. Overall patients received 145 cycles with
OND and 159 cycles with MCP. Of the 76 patients receiving OND-based
antiemetic regimen during the first cycle, 13 (21%) experienced severe
vomiting (Grade 2, 3) and the remaining 63 (79%) had mild or no
vomiting (Grade 0, 1). Patients with Grade 0, 1 vomiting (63, 83%)
continued with MCP in the second cycle. The final number of patients who
failed on MCP after 4 cycles of chemotherapy increased to 33 (43 %); 43
(57 %) were able to complete chemotherapy with MCP. Headache occurred
in 15 (10 %) cycles with OND and 8 (5 %) with MCP. Flushing was noted
in 12 (8 %), and constipation occurred in 43 (30 %) of OND cycles, and
extrapyramidal manifestations occurred in 3 (5 %) of patients receiving
MCP. Diarrhea was noted in 3 (2 %) of cycles with OND and in 28 (18 %)
with MCP. The cost ratio between MCP and OND wets 1:14. If we
administered OND only in patients who needed it, the overall cost
decreased to 44 %. Following the strategy applied in the present study,
the cost decreased to 47 %. (C) U.S. Cancer-Pain Relief Committee,
1999