Which of the following is highly emetogenic:
|B||High dose methotrexate|
|C||High dose cyclophosphamide|
Nausea & vomiting is a prominent feature of many of cytotoxic drugs. This is due to CTZ stimulation as well as generating the emetogenic stimuli from upper GIT as well as other areas.
The drugs can be classified depending on their emetogenic potential as follows
A. High emetogenic – cisplatin, mustine, cyclophosphamide, actinomycin D, dacarbazine, lomustine.
B. Moderate – carboplatin, cytarabine, procarbazine, vinblastine, doxorubicin, daunorubicin, ifosfamide, 6-mercarptopurine.
C. Mild – bleomycin, chlorambucil, busulfan, fluorouracil, 6-thioguanine, hydroxyurea, vincristine, methotrexate, etoposide and l-asparaginase.
However Harrison, 17th, mentions –
D. Highly emetogenic drugs (>90%) include mechlorethamine, streptozotocin, DTIC, cyclophosphamide at >1500 mg/m2, and cisplatin;
E. Moderately emetogenic drugs (30–90% risk) include carboplatin, cytosine arabinoside (>1 mg/m2), ifosfamide, conventional-dose cyclophosphamide, and anthracycline;
F. Low-risk (10–30%) agents include fluorouracil, taxanes, etoposide, and bortezomib, with minimal risk (<10%) afforded by treatment with antibodies, bleomycin, busulfan, fludarabine, and vinca alkaloids.
Also, Nausea may be acute (within 24 h of chemotherapy), delayed (>24 h), or anticipatory of the receipt of chemotherapy. Risk factors include - young, female, heavily pretreated patients without a history of alcohol or drug use but with a history of motion or morning sickness.
Drugs which are effective in cancer chemotherapy indued vomiting–
A. Variety of 5-HT3 receptor antagonists – granisetron, palanocetron, ondansetron etC.
B. NK1 antagonists – Aprepitant