Oncology reports
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Randomized Controlled Trial Clinical Trial
Comparison of oral 5-HT3-receptor antagonists and low-dose oral metoclopramide plus i.m. dexamethasone for the prevention of delayed emesis in head and neck cancer patients receiving high-dose cisplatin.
A phase III, single-institution, open, prospective, randomized, parallel study was carried out on head and neck cancer patients to compare a combination of low-dose (20 mg q.i.d.) oral metoclopramide (M) + i.m. Dexamethasone (D) with an oral 5-HT3-Receptor Antagonist (5-HT3-RA) alone in the prevention of high-dose (HD > or = 80 mg/m2) cisplatin-induced delayed emesis. 51 consecutive patients, all but two with advanced stage of disease, were treated for a total of 198 chemotherapic cycles: 23 patients entered Group A (5-HT3-RA) receiving a total of 108 cycles, 28 patients entered Group B (M + D) receiving a total of 90 cycles. The treatment groups were well matched for age, sex (almost all patients were males), ECOG PSR, stage of disease and alcohol intake. ⋯ Our results show that M + D are more effective than 5-HT3-RA alone in the prevention of HD cisplatin induced delayed emesis, whereas 5-HT3-RA may be the treatment of choice in patients who had acute vomiting. Our study demonstrated not only the persistence of antiemetic efficacy but also increasing efficacy, during subsequent courses. Our results confirm that protection from acute emesis plays a major role in the appearance and control of delayed emesis.
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To combine the rapid hypocalcemic effects of calcitonin with the delayed effects of pamidronate, a combination of a single dose of pamidronate and serial doses of eel calcitonin was administered to five patients with malignant hypercalcemia for 2 to 5 days. The serum calcium levels of all five patients fell within 24 h after administration of pamidronate and the first dose of calcitonin and decreased to normal within 4 days. ⋯ The results of this study demonstrate the value of combining the rapidly acting antiresorptive and renal calciuretic effects of calcitonin with the slower, but more potent effects of pamidronate. The combination of calcitonin and pamidronate allowed rapid, long-term control of hypercalcemia and it is regarded as the first choice of treatment in severe hypercalcemia.