Current opinion in oncology
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Despite major progress in the treatment of chemotherapy-induced emesis, nearly one third of patients undergoing cisplatin-based regimens still experience emesis within the first 24 hours of chemotherapy. An adequate treatment of delayed and anticipatory emesis remains to be determined. For highly emetogenic chemotherapy, the combination of ondansetron and dexamethasone is superior to dexamethasone alone and protects most patients. ⋯ This would suggest that, to reduce the cost of antiemetic therapy, ondansetron can be limited in case of failure of standard therapy. Delayed emesis remains poorly controlled with no difference between metoclopramide, dexamethasone, ondansetron, and placebo. Although some data suggest an improved efficacy when combining ondansetron with dexamethasone, convincing confirmatory studies are needed.
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Patients with neoplastic diseases are predisposed to develop invasive fungal infections as the result of impairments of host defense mechanisms due principally to pharmacologic immunosuppression resulting from intensive cytotoxic chemotherapy, ablative radiation therapy, and corticosteroids. Candida species, Aspergillus species, and emerging opportunistic fungal pathogens comprise the principal etiologic agents of opportunistic mycoses in cancer patients. This paper reviews the recent progress, particularly during the year of 1991, in management of invasive fungal infections and the current problems of invasive mycosis, which confront patients with neoplastic diseases.