Recomendaciones para la prevención y el tratamiento de náuseas y vómitos inducidos por quimioterapia
Palabras clave:
EMESIS, NÁUSEA, QUIMIOTERAPIA, ANTIEMÉTICOS
Resumen
Las náuseas y los vómitos son uno de los efectos adversos más frecuentes de la quimioterapia, y uno de los más temidos por los pacientes. El adecuado control de la emesis aguda y tardía redunda en una mejor calidad de vida y una mayor adhesión de los pacientes al tratamiento. A pesar de disponerse actualmente de estrategias antieméticas más efectivas, es frecuente su empleo inadecuado ya sea por su sobre o subutilización.
El objetivo de este trabajo es establecer guías precisas para la prevención y el tratamiento de náuseas y vómitos inducidos por quimioterapia, aplicables a nuestro medio, procurando mantener una adecuada relación costo-beneficio.
Los factores de riesgo para las náuseas y vómitos inducidos por quimioterapia son dependientes del paciente y dependientes del tratamiento, siendo la emetogenicidad propia del plan de quimioterapia el más importante. En las situaciones de alto riesgo de náuseas y vómitos inducidos por quimioterapia (cisplatino, ciclofosfamida, adriamicina, entre otras), la combinación de un antagonista 5HT3 más corticoide previene más efectivamente la emesis aguda que otras combinaciones previamente empleadas. En la profilaxis de la emesis tardía no se ha demostrado la superioridad del uso de antagonistas 5HT3, por lo que su mayor costo no justifica su empleo inicial. En las situaciones de riesgo intermedio (5-Fu, taxanos, etopósido) el tratamiento con corticoides o metoclopramida sería suficiente, no recomendándose de inicio profilaxis de la emesis tardía. Para las situaciones de bajo riesgo (bleomicina, vinca) no se sugiere profilaxis de náuseas y vómitos inducidos por quimioterapia. Los antieméticos vía oral son igualmente efectivos que los intravenosos, por lo que por su costo y su conveniencia serían de preferencia.
Citas
1) Coates A, Abraham S, Kaye SB, Sowerbutts T, Frewin C, Fox RM, et al. On the receiving end—patient perception of the side-effects of cancer chemotherapy. Eur J Cancer Clin Oncol 1983; 19: 203-8.
2) Osoba D, Zee B, Warr D, Kaizer L, Latreille J, Pater J. Quality of life studies in chemotherapy-induced emesis. Oncology 1996; 53 (Suppl 1): 92-5.
3) Koski S, Venner P. Chemotherapy-induced nausea and vomiting. In: Nabholtz JM, Tonkin K, Aapro M, Buzdar A, ed. Breast cancer management: application of evidence to patient care. London: Martin Dunitz, 2000: 317-29.
4) Griffin AM, Butow PN, Coates AS, Childs AM, Ellis PM, Dunn SM, et al. On the receiving end. V: Patient perceptions of the side effects of cancer chemotherapy in 1993. Ann Oncol 1996; 7(2): 189-95.
5) Kaizer L, Warr D, Hoskins P, Latreille J, Lofters W, Yau J, et al. Effect of schedule and maintenance on the antiemetic efficacy of ondansetron combined with dexamethasone in acute and delayed nausea and emesis in patients receiving moderately emetogenic chemotherapy: a phase III trial by the National Cancer Institute of Canada Clinical Trials Group. J Clin Oncol 1994; 12: 1050-7.
6) Osoba D, Warr DG, Fitch MI, Nakashima L, Warren B. Guidelines for the optimal management of chemotherapy-induced nausea and vomiting: a consensus. Can J Oncol 1995; 5: 381-400.
7) Kris MG, Gralla RJ, Clark RA. Incidence, course, and severity of delayed nausea and vomiting following the administration of high-dose cisplatin. J Clin Oncol 1985; 3: 1379-84.
8) Gralla RJ, Osoba D, Kris MG, Kirkbride P, Hesketh PJ, Lawrence WC, et al. Recommendations for the use of antiemetics: evidence-based, clinical practice guidelines. J Clin Oncol 1999; 17: 2971-94.
9) Boakes RA, Tarrier N, Barnes BW, Tattersall MH. Prevalence of anticipatory nausea and other side-effects in cancer patients receiving chemotherapy. Eur J Cancer 1993; 29A: 866-70.
10) Hesketh PJ. Defining the emetogenicity of cancer chemotherapy regimens: relevance to clinical practice. Oncologist 1999; 4: 191-6.
11) Gregory RE, Ettinger DS. 5-HT3 receptor antagonists for the prevention of chemotherapy-induced nausea and vomiting: a comparison of their pharmacology and clinical efficacy. Drugs 1998; 55: 173-89.
12) Schnell FM. Chemotherapy-induced nausea and vomiting: the importance of acute antiemetic control. Oncologist 2003; 8: 187-98.
13) Grunberg SM, Hesketh PJ. Control of chemotherapy-induced emesis. N Engl J Med 1993; 329: 1790-6.
14) Naylor RJ, Rudd JA. Mechanisms of chemotherapy/radiotherapy-induced emesis in animal models. Oncology 1996; 53 (Suppl 1): 8-17.
15) Andrews PL, Bhandari P. The 5-hydroxytryptamine receptor antagonists as antiemetics: preclinical evaluation and mechanism of action. Eur J Cancer 1998; 29A: S11-S16.
16) Cubeddu LX. Serotonin mechanisms in chemotherapy-induced emesis in cancer patients. Oncology 1996; 53 (Suppl 1): 18-25.
17) Hesketh PJ. Potential role of the NK1 receptor antagonists in chemotherapy-induced nausea and vomiting. Support Care Cancer 2001; 9(5): 350-4.
18) Laszlo J. Treatment of nausea and vomiting caused by cancer chemotherapy. Cancer Treat Rev 1982; 9 (Suppl B): 3-9.
19) Lindley CM, Bernard S, Fields SM. Incidence and duration of chemotherapy-induced nausea and vomiting in the outpatient oncology population. J Clin Oncol 1989; 7: 1142-9.
20) Aapro MS. Methodological issues in atiemetic studies. Invest N Drugs 1993; 11: 243-53.
21) Jantunen IT, Flander MK, Heikkinen MI, Kuoppala TA, Teerenhovi L, Kataja VV. Comparison of ondansetron with customary treatment in the prophylaxis of nausea and emesis induced by non-cisplatin containing chemotherapy. Acta Oncol 1993; 32: 413-5.
22) Jantunen IT, Kataja VV, Muhonen TT. An overview of randomised studies comparing 5-HT3 receptor antagonists to conventional anti-emetics in the prophylaxis of acute chemotherapy-induced vomiting. Eur J Cancer 1997; 33: 66-74.
23) Gebbia V, Testa A, Valenza R, Cannata G, Tirrito ML, Gebbia N. Oral granisetron with or without methylprednisolone versus metoclopramide plus methylprednisolone in the management of delayed nausea and vomiting induced by cisplatin-based chemotherapy. A prospective randomized trial. Cancer 1995; 76: 1821-8.
24) Navari RM, Province WS, Perrine GM, Kilgore JR. Comparison of intermittent ondansetron versus continuous infusion metoclopramide used with standard combination antiemetics in control of acute nausea induced by cisplatin chemotherapy. Cancer 1993; 72: 583-6.
25) Roila F, Tonato M, Basurto C. Protection from nausea and vomiting in cisplatin-treated patients: high-dose metoclopramide combined with methylprednisolone versus metoclopramide combined with dexamethasone and diphenydramine: study of the Italian Oncology Group for Clinical Research. J Clin Oncol 1989; 7: 1693-700.
26) Roila F. Control of acute cisplatin-induced emesis over repeat courses of chemotherapy. Italian Group for Antiemetic Research. Oncology 1996; 53 (Suppl 1): 65-72.
27) Gebbia V, Cannata G, Testa A, Curto G, Valenza R, Cipolla C, et al. Ondansetron versus granisetron in the prevention of chemotherapy-induced nausea and vomiting. Results of a prospective randomized trial. Cancer 1994; 74: 1945-52.
28) Beck TM, York M, Chang A, Navari R, Harvey WH, Meshad M, et al. Oral ondansetron 8 mg twice daily is as effective as 8 mg three times daily in the prevention of nausea and vomiting associated with moderately emetogenic cancer chemotherapy. S3A-376 Study Group. Cancer Invest 1997; 15: 297-303.
29) Bonneterre J, Hecquet B. Granisetron (IV) compared with ondansetron (IV plus oral) in the prevention of nausea and vomiting induced by moderately-emetogenic chemotherapy. A cross-over study. Bull Cancer 1995; 82: 1038-43.
30) Hesketh P, Navari R, Grote T, Gralla R, Hainsworth J, Kris M, et al. Double-blind, randomized comparison of the antiemetic efficacy of intravenous dolasetron mesylate and intravenous ondansetron in the prevention of acute cisplatin-induced emesis in patients with cancer. Dolasetron Comparative Chemotherapy-induced Emesis Prevention Group. J Clin Oncol 1996; 14: 2242-9.
31) Lofters WS, Pater JL, Zee B, Dempsey E, Walde D, Moquin JP, et al. Phase III double-blind comparison of dolasetron mesylate and ondansetron and an evaluation of the additive role of dexamethasone in the prevention of acute and delayed nausea and vomiting due to moderately emetogenic chemotherapy. J Clin Oncol 1997; 15: 2966-73.
32) Ettinger DS, Eisenberg PD, Fitts D, Friedman C, Wilson-Lynch K, Yocom K. A double-blind comparison of the efficacy of two dose regimens of oral granisetron in preventing acute emesis in patients receiving moderately emetogenic chemotherapy. Cancer 1996; 78: 144-51.
33) Perez EA, Hesketh P, Sandbach J, Reeves J, Chawla S, Markman M, et al. Comparison of single-dose oral granisetron versus intravenous ondansetron in the prevention of nausea and vomiting induced by moderately emetogenic chemotherapy: a multicenter, double-blind, randomized parallel study. J Clin Oncol 1998; 16: 754-60.
34) Clavel M, Bonneterre J, d’Allens H, Paillarse JM. Oral ondansetron in the prevention of chemotherapy-induced emesis in breast cancer patients. French Ondansetron Study Group. Eur J Cancer 1995; 31A: 15-9.
35) Goedhals L, Heron JF, Kleisbauer JP, Pagani O, Sessa C. Control of delayed nausea and vomiting with granisetron plus dexamethasone or dexamethasone alone in patients receiving highly emetogenic chemotherapy: a double-blind, placebo-controlled, comparative study. Ann Oncol 1998; 9: 661-6.
36) Heron JF. Single-agent granisetron for the prevention of acute cisplatin-induced emesis: a double-bind, randomized comparison with granisetron plus dexamethasone and high-dose metoclopramide plus dexamethasone. Semin Oncol 1995; 22 (4 Suppl 10): 24-30.
37) Italian Group for Antiemetic Research. Double-blind, dose-finding study of four intravenous dosis of dexamethasone in the prevention of cisplatin-induced acute emesis. J Clin Oncol 1998; 16: 2937-42.
38) Koo WH, Ang PT. Role of maintenance oral dexamethasone in prophylaxis of delayed emesis caused by moderately emetogenic chemotherapy. Ann Oncol 1996; 7: 71-4.
39) Campora E, Giudici S, Merlini L, Rubagotti A, Rosso R. Ondansetron and dexamethasone versus standard combination antiemetic therapy. A randomized trial for the prevention of acute and delayed emesis induced by cyclophosphamide-doxorubicin chemotherapy and maintenance of antiemetic effect at subsequent courses. Am J Clin Oncol 1994; 17: 522-6.
40) Italian Group for Antiemetic Research. Ondansetron versus metoclopramide, both combined with dexamethasone in the prevention of cisplatin-induced delayed emesis. J Clin Oncol 1997; 15: 124-30.
41) Morrow GR, Morrell C. Behavioral treatment for the anticipatory nausea and vomiting induced by cancer chemotherapy. N Engl J Med 1982; 307: 1476-80.
2) Osoba D, Zee B, Warr D, Kaizer L, Latreille J, Pater J. Quality of life studies in chemotherapy-induced emesis. Oncology 1996; 53 (Suppl 1): 92-5.
3) Koski S, Venner P. Chemotherapy-induced nausea and vomiting. In: Nabholtz JM, Tonkin K, Aapro M, Buzdar A, ed. Breast cancer management: application of evidence to patient care. London: Martin Dunitz, 2000: 317-29.
4) Griffin AM, Butow PN, Coates AS, Childs AM, Ellis PM, Dunn SM, et al. On the receiving end. V: Patient perceptions of the side effects of cancer chemotherapy in 1993. Ann Oncol 1996; 7(2): 189-95.
5) Kaizer L, Warr D, Hoskins P, Latreille J, Lofters W, Yau J, et al. Effect of schedule and maintenance on the antiemetic efficacy of ondansetron combined with dexamethasone in acute and delayed nausea and emesis in patients receiving moderately emetogenic chemotherapy: a phase III trial by the National Cancer Institute of Canada Clinical Trials Group. J Clin Oncol 1994; 12: 1050-7.
6) Osoba D, Warr DG, Fitch MI, Nakashima L, Warren B. Guidelines for the optimal management of chemotherapy-induced nausea and vomiting: a consensus. Can J Oncol 1995; 5: 381-400.
7) Kris MG, Gralla RJ, Clark RA. Incidence, course, and severity of delayed nausea and vomiting following the administration of high-dose cisplatin. J Clin Oncol 1985; 3: 1379-84.
8) Gralla RJ, Osoba D, Kris MG, Kirkbride P, Hesketh PJ, Lawrence WC, et al. Recommendations for the use of antiemetics: evidence-based, clinical practice guidelines. J Clin Oncol 1999; 17: 2971-94.
9) Boakes RA, Tarrier N, Barnes BW, Tattersall MH. Prevalence of anticipatory nausea and other side-effects in cancer patients receiving chemotherapy. Eur J Cancer 1993; 29A: 866-70.
10) Hesketh PJ. Defining the emetogenicity of cancer chemotherapy regimens: relevance to clinical practice. Oncologist 1999; 4: 191-6.
11) Gregory RE, Ettinger DS. 5-HT3 receptor antagonists for the prevention of chemotherapy-induced nausea and vomiting: a comparison of their pharmacology and clinical efficacy. Drugs 1998; 55: 173-89.
12) Schnell FM. Chemotherapy-induced nausea and vomiting: the importance of acute antiemetic control. Oncologist 2003; 8: 187-98.
13) Grunberg SM, Hesketh PJ. Control of chemotherapy-induced emesis. N Engl J Med 1993; 329: 1790-6.
14) Naylor RJ, Rudd JA. Mechanisms of chemotherapy/radiotherapy-induced emesis in animal models. Oncology 1996; 53 (Suppl 1): 8-17.
15) Andrews PL, Bhandari P. The 5-hydroxytryptamine receptor antagonists as antiemetics: preclinical evaluation and mechanism of action. Eur J Cancer 1998; 29A: S11-S16.
16) Cubeddu LX. Serotonin mechanisms in chemotherapy-induced emesis in cancer patients. Oncology 1996; 53 (Suppl 1): 18-25.
17) Hesketh PJ. Potential role of the NK1 receptor antagonists in chemotherapy-induced nausea and vomiting. Support Care Cancer 2001; 9(5): 350-4.
18) Laszlo J. Treatment of nausea and vomiting caused by cancer chemotherapy. Cancer Treat Rev 1982; 9 (Suppl B): 3-9.
19) Lindley CM, Bernard S, Fields SM. Incidence and duration of chemotherapy-induced nausea and vomiting in the outpatient oncology population. J Clin Oncol 1989; 7: 1142-9.
20) Aapro MS. Methodological issues in atiemetic studies. Invest N Drugs 1993; 11: 243-53.
21) Jantunen IT, Flander MK, Heikkinen MI, Kuoppala TA, Teerenhovi L, Kataja VV. Comparison of ondansetron with customary treatment in the prophylaxis of nausea and emesis induced by non-cisplatin containing chemotherapy. Acta Oncol 1993; 32: 413-5.
22) Jantunen IT, Kataja VV, Muhonen TT. An overview of randomised studies comparing 5-HT3 receptor antagonists to conventional anti-emetics in the prophylaxis of acute chemotherapy-induced vomiting. Eur J Cancer 1997; 33: 66-74.
23) Gebbia V, Testa A, Valenza R, Cannata G, Tirrito ML, Gebbia N. Oral granisetron with or without methylprednisolone versus metoclopramide plus methylprednisolone in the management of delayed nausea and vomiting induced by cisplatin-based chemotherapy. A prospective randomized trial. Cancer 1995; 76: 1821-8.
24) Navari RM, Province WS, Perrine GM, Kilgore JR. Comparison of intermittent ondansetron versus continuous infusion metoclopramide used with standard combination antiemetics in control of acute nausea induced by cisplatin chemotherapy. Cancer 1993; 72: 583-6.
25) Roila F, Tonato M, Basurto C. Protection from nausea and vomiting in cisplatin-treated patients: high-dose metoclopramide combined with methylprednisolone versus metoclopramide combined with dexamethasone and diphenydramine: study of the Italian Oncology Group for Clinical Research. J Clin Oncol 1989; 7: 1693-700.
26) Roila F. Control of acute cisplatin-induced emesis over repeat courses of chemotherapy. Italian Group for Antiemetic Research. Oncology 1996; 53 (Suppl 1): 65-72.
27) Gebbia V, Cannata G, Testa A, Curto G, Valenza R, Cipolla C, et al. Ondansetron versus granisetron in the prevention of chemotherapy-induced nausea and vomiting. Results of a prospective randomized trial. Cancer 1994; 74: 1945-52.
28) Beck TM, York M, Chang A, Navari R, Harvey WH, Meshad M, et al. Oral ondansetron 8 mg twice daily is as effective as 8 mg three times daily in the prevention of nausea and vomiting associated with moderately emetogenic cancer chemotherapy. S3A-376 Study Group. Cancer Invest 1997; 15: 297-303.
29) Bonneterre J, Hecquet B. Granisetron (IV) compared with ondansetron (IV plus oral) in the prevention of nausea and vomiting induced by moderately-emetogenic chemotherapy. A cross-over study. Bull Cancer 1995; 82: 1038-43.
30) Hesketh P, Navari R, Grote T, Gralla R, Hainsworth J, Kris M, et al. Double-blind, randomized comparison of the antiemetic efficacy of intravenous dolasetron mesylate and intravenous ondansetron in the prevention of acute cisplatin-induced emesis in patients with cancer. Dolasetron Comparative Chemotherapy-induced Emesis Prevention Group. J Clin Oncol 1996; 14: 2242-9.
31) Lofters WS, Pater JL, Zee B, Dempsey E, Walde D, Moquin JP, et al. Phase III double-blind comparison of dolasetron mesylate and ondansetron and an evaluation of the additive role of dexamethasone in the prevention of acute and delayed nausea and vomiting due to moderately emetogenic chemotherapy. J Clin Oncol 1997; 15: 2966-73.
32) Ettinger DS, Eisenberg PD, Fitts D, Friedman C, Wilson-Lynch K, Yocom K. A double-blind comparison of the efficacy of two dose regimens of oral granisetron in preventing acute emesis in patients receiving moderately emetogenic chemotherapy. Cancer 1996; 78: 144-51.
33) Perez EA, Hesketh P, Sandbach J, Reeves J, Chawla S, Markman M, et al. Comparison of single-dose oral granisetron versus intravenous ondansetron in the prevention of nausea and vomiting induced by moderately emetogenic chemotherapy: a multicenter, double-blind, randomized parallel study. J Clin Oncol 1998; 16: 754-60.
34) Clavel M, Bonneterre J, d’Allens H, Paillarse JM. Oral ondansetron in the prevention of chemotherapy-induced emesis in breast cancer patients. French Ondansetron Study Group. Eur J Cancer 1995; 31A: 15-9.
35) Goedhals L, Heron JF, Kleisbauer JP, Pagani O, Sessa C. Control of delayed nausea and vomiting with granisetron plus dexamethasone or dexamethasone alone in patients receiving highly emetogenic chemotherapy: a double-blind, placebo-controlled, comparative study. Ann Oncol 1998; 9: 661-6.
36) Heron JF. Single-agent granisetron for the prevention of acute cisplatin-induced emesis: a double-bind, randomized comparison with granisetron plus dexamethasone and high-dose metoclopramide plus dexamethasone. Semin Oncol 1995; 22 (4 Suppl 10): 24-30.
37) Italian Group for Antiemetic Research. Double-blind, dose-finding study of four intravenous dosis of dexamethasone in the prevention of cisplatin-induced acute emesis. J Clin Oncol 1998; 16: 2937-42.
38) Koo WH, Ang PT. Role of maintenance oral dexamethasone in prophylaxis of delayed emesis caused by moderately emetogenic chemotherapy. Ann Oncol 1996; 7: 71-4.
39) Campora E, Giudici S, Merlini L, Rubagotti A, Rosso R. Ondansetron and dexamethasone versus standard combination antiemetic therapy. A randomized trial for the prevention of acute and delayed emesis induced by cyclophosphamide-doxorubicin chemotherapy and maintenance of antiemetic effect at subsequent courses. Am J Clin Oncol 1994; 17: 522-6.
40) Italian Group for Antiemetic Research. Ondansetron versus metoclopramide, both combined with dexamethasone in the prevention of cisplatin-induced delayed emesis. J Clin Oncol 1997; 15: 124-30.
41) Morrow GR, Morrell C. Behavioral treatment for the anticipatory nausea and vomiting induced by cancer chemotherapy. N Engl J Med 1982; 307: 1476-80.
Publicado
2004-08-31
Cómo citar
1.
Fresco R, Suárez L. Recomendaciones para la prevención y el tratamiento de náuseas y vómitos inducidos por quimioterapia. Rev. Méd. Urug. [Internet]. 31 de agosto de 2004 [citado 18 de diciembre de 2024];20(2):120-9. Disponible en: https://www2.rmu.org.uy/ojsrmu311/index.php/rmu/article/view/917
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