January 1, 1989Journal of Clinical Oncology
Controlling delayed vomiting: double-blind, randomized trial comparing placebo, dexamethasone alone, and metoclopramide plus dexamethasone in patients receiving cisplatin.
Authors
Discussion
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Implication
Randomized double-blind trial shows metoclopramide combined with dexamethasone reduces delayed vomiting in patients receiving cisplatin, indicating superior antiemetic efficacy.
Key Points
- To evaluate the efficacy and safety of oral dexamethasone alone versus oral metoclopramide plus dexamethasone versus placebo in preventing delayed emesis following cisplatin chemotherapy.
- Double-blind randomized trial involving 91 patients receiving their initial cycle of high-dose cisplatin (120 mg/m2).
- All participants received standardized intravenous metoclopramide, dexamethasone, and lorazepam to control acute emesis (0–24 hours post-chemotherapy).
- Patients were randomized to receive oral placebo, oral dexamethasone alone (8 mg twice daily for two days, then 4 mg twice daily for two days), or oral metoclopramide (0.5 mg/kg four times daily) plus oral dexamethasone for 24–120 hours post-chemotherapy.
- Delayed vomiting occurred in 48% of patients receiving metoclopramide plus dexamethasone versus 65% receiving dexamethasone alone and 89% receiving placebo (P = .006).
- Incidences of adverse events—including sleepiness, restlessness, heartburn, hiccoughs, loose stools, insomnia, and acute dystonic reactions—did not differ significantly among the three regimens and were mild and self-limited.
Cite This Study
Kris et al. (1989) studied this question.