The combination of gemcitabine and cisplatin (GC) is a standard regimen for advanced urothelial cancer (UC). Although this is a highly emetogenic chemotherapy, there has been no study concerning antiemetic prophylaxis for chemotherapy-induced nausea and vomiting (CINV) during GC. The aims of this study were to evaluate CINV during GC and to compare the antiemetic efficacy of the triple combination of palonosetron, aprepitant and dexamethasone with that of our old regimen using ondansetron and dexamethasone.Methods
We conducted a retrospective review of the medical records of 52 patients who received GC for advanced urothelial cancer between February 2005 and January 2012. Uncontrolled CINV events were identified through records of nausea and vomiting, additional infusion, rescue medications and/or records of food intake. Nausea, vomiting and anorexia were classified using the Common Terminology Criteria for Adverse Events (CTCAE) ver4.0.Results
A total of 23 and 29 patients were treated with ondansetron–dexamethasone (group 1) and palonosetron with dexamethasone–aprepitant (group 2), respectively. There was no significant difference in age, gender or the dose of cisplatin between the two groups. Patients in group 2 were more likely to achieve more favorable CINV control, e.g. a lower grade of nausea, vomiting or anorexia, lower incidence of rescue therapy required and shorter time to become CINV-free, than patients in group 1.Conclusions
This study shows that palonosetron in combination with aprepitant and dexamethasone is more effective to prevent chemotherapy-induced nausea and vomiting in UC patients treated with GC than ondansetron–dexamethasone.