Introduction
5-HT3 receptor antagonists (5-HT3RAs) are the most commonly recommended agents for the prophylaxis of radiotherapy-induced nausea and vomiting (RINV) within international antiemetic guidelines. However, the optimal timing and duration of their administration is unknown. We reviewed the relevant literature as a first step in addressing this important issue in supportive care.
Methods
EMBASE and EMBASE Classic, Ovid MEDLINE, the Cochrane Database of Systematic Reviews and the Cochrane Central Register of Controlled Trials were searched for articles reporting on patient cohorts receiving prophylactic therapy with a 5-HT3RA and being prospectively evaluated for RINV. Cohorts were grouped into high-, moderate-, and low-emetic-risk categories according to international guidelines.
Results
The search identified 599 references, and 25 were included in the review. These contained 33 discrete patient cohorts (cumulative n = 1,067) that were prospectively evaluated for RINV while receiving prophylactic 5-HT3RA therapy. Of the 11 high-emetic-risk radiotherapy cohorts, two, eight, and one received 5-HT3RAs for durations longer than, equal to, or shorter than the duration of radiotherapy, respectively. Of the 22 moderate or low-emetic-risk radiotherapy cohorts, 5, 14, and 3 received 5-HT3RAs for durations longer than, equal to, or shorter than the duration of radiotherapy, respectively. Radiotherapy regimens and study endpoints were heterogeneous, precluding statistical comparisons of prophylaxis strategies.
Conclusion
5-HT3RAs were most commonly administered for the entire duration of a course of radiotherapy. Future studies should compare different timings and durations of therapy with common efficacy endpoints to develop effective and cost-efficient antiemetic strategies.