Nausea/vomiting chemotherapy-related

Overall survival is affected by the success of the initial surgery to debulk the tumor to less than 1 cm of disease and response to first-line chemotherapy. The CA-125 level should be monitored with each cycle, and at least a 50% reduction in CA-125 after four cycles of taxane/platinum chemotherapy is related to an improved prognosis. Patients who achieve a complete response should have follow-up examinations every 3 months, including CA-125 determination, physical examination, pelvic examination, and appropriate diagnostic scans (e.g., CT scan, MRI, or PET scan) and should be evaluated for the detection of disease. Evaluate patients for resolution of any residual chemotherapy-related side effects, including neuropathies, nephrotoxicity, ototoxicity, myelosuppression, and nausea/vomiting. 

Secondary or unwanted effects. Problems that occru when treatment affects healthy cells. For instance, the common side effects of chemotherapy include fatigue, nausea, vomiting, decreased blood ceU counts, and hair loss. Most treatment-related side effects can be managed. 

Benzodiazepines and their congeners may help prevent central cortical-induced vomiting. A prominent side effect is drowsiness. They are frequently used in combination with other antiemetics for treating chemotherapy-related nausea and vomiting. Discussion of these agents is found in Chapter 30. 

A total of 503 interventions were reported clinical consultations, correction of prescribing eiTors, and patient treatment procedures accounted for approximately two-thirds of the interventions (Table 6). In this study, all clinical interventions were related to chemotherapy-related toxicides or drug-dosing and -administration issues. The 167 documented clinical consultations were related to nausea or vomiting (29.3%), chemotherapy dosing or... 

Carboplatin is a cytotoxic platinium complex structurally related to cisplatin, which antitumor activity in vitro is qualitatively similar to that of cisplatin. Comparative trials with carboplatin alone or in combination with other chemotherapeutic agents suggest comparable efficacy with cisplatin in ovarian cancer. As with cisplatin, nausea and vomiting occur in many patients but symptoms are usually delayed for several hours and mild to moderate in severity. The dose limiting toxicity of carboplatin is myelosuppression enhanced by renal impairment, previous chemotherapy or in older patients. 

E Lorazepam is most effective for anticipatory nausea and vomiting, or emesis that oaurs prior to chemotherapy administration. The antiemetic effects may be related to the sedative and anxiolytic properties of lorazepam. 5-HT3 antagonists and dopamine antagonists are poor choices because efficacy has not been shown in anticipatory nausea and vomiting. 

A related anthracenedione, mitoxantrone, has been approved for use in AML. Mitoxantrone has limited ability to produce quinone-type free radicals and causes less cardiac toxicity than does doxorubicin. It produces acute myelosuppression, cardiac toxicity, and mucositis as its major toxicities the drug causes less nausea and vomiting and alopecia than does doxorubicin. It is also used as a component of experimental high-dose chemotherapy regimens, with uncertain efficacy. 

A -frar s-Tetrahydrocannabinol (THC) is the major psychoactive (euphoriant) constituent of marijuana. Cannabis sativa. The synthetic form of THC (dronabinol) was approved approximately 20 years ago to treat nausea and vomiting associated with cancer chemotherapy, and it has been used for a lesser amount of time to treat appetite loss in patients with HIV/AIDS (44). More recently, an approximately 1 1 mixture of THC and the structurally related marijuana constituent cannabidiol has been approved in Canada for the alleviation of neuropathic pain and spasticity fcr patients with multiple sclerosis and is administered in low doses as a buccal spray (53). Ccnsiderable interest exists in using cannabinoid derivatives based on THC for medicinal purpcses, but it is necessary to minimize the central nervous system effects of these compounds. 

Ondansetron versus palonosetron In a randomized, open comparison of ondansetron and palonosetron in the treatment of chemotherapy-induced nausea and vomiting in 143 patients with acute myelogenous leukemia receiving high-dose cytarabine, the two drugs were equally efficacious [26 ]. The most common treatment-related adverse events were constipation and headache and 22 patients reported events that were possibly or probably related to ondansetron or palonosetron. There were no cardiac adverse events that were considered possibly or probably related to ondansetron or palonosetron. 

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