| |
Posttreatment Nausea
& Vomiting
There is a generally held belief that severe nausea and vomiting
are inevitable consequences of cancer chemotherapy. This is clearly
not true; the emetogenic potential of chemotherapeutic agents,
when patients receive them in the absence of effective antiemetic
prophylaxis, varies dramatically.
In Table 2 it can be
seen that drugs in level 5, e.g. cisplatin, are almost certain
to cause emesis; whereas others, e.g. bleomycin in Level 1, are
unlikely to cause emesis. The investigators who compiled this
table also created an algorithm for predicting the emetogenicity
of combinations of chemotherapy agents (Hesketh
et al., 1997). In actual practice, vomiting occurs less frequently
than numbers in the table would indicate because virtually all
patients receiving chemotherapy receive antiemetic medications.
| Table
2. Emetogenic Potential of Chemotherapy Agents
|
|---|
| Level
| Frequency
of emesis (%)*
| Agent
|
|---|
|
5
|
>90
| Carmustine
> 250 mg/m2
Cisplatin > 50 mg/m2
Cyclophosphamide > 1,500 mg/m2
Dacarbazine
Mechlorethamine
Streptozocin |
|
4
|
60-90
| Carboplatin
Carmustine < 250 mg/m2
Cisplatin < 50 mg/m2
Cyclophosphamide > 750 mg/m2
< 1,500 mg/m2
Cytarabine > 1 g/m2
Doxorubicin > 60 mg/m2
Methotrexate > 1,000 mg/m2
Procarbazine (oral) |
|
3
|
30-60
| Cyclophosphamide
< 750 mg/m2
Cyclophosphamide (oral)
Doxorubicin 20-60 mg/m2
Epirubicin < 90 mg/m2
Hexamethylmelamine (oral)
Idarubicin
Ifosfamide
Irinotecan
Methotrexate 250-1,000 mg/m2
Mitoxantrone < 15 mg/m2
|
|
2
|
10-30
| Capecitabine
Docetaxel
Etoposide
5-Fluorouracil < 1,000 mg/m2
Gemcitabine
Methotrexate > 50 mg/m2
< 250 mg/m2
Mitomycin
Paclitaxel
Topotecan |
|
1
|
<10
| Bleomycin
Busulfan
Chlorambucil (oral)
2-Chlorodeoxyadenosine
Fludarabine
Hydroxyurea
Methotrexate < 50 mg/m2
L-phenylalanine mustard (oral)
Thioguanine (oral)
Vinblastine
Vincristine
Vinorelbine |
|
*Proportion
of patients who experience emesis in the absence of effective
antiemetic prophylaxis.
Source:
Hesketh PJ, Kris MG, Grunberg SM, et al. Proposal for classifying
the acute emetogenicity of cancer chemotherapy. J Clin
Oncol. 1997;15(1):103-109. Reprinted with permission
of LWW.
|
|