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Efficacy of Oral Ondansetron in the Prevention of Emesis in Outpatients Receiving Cyclophosphamide-based Chemotherapy

Thomas M. Beck, MD; Arthur A. Ciociola, PhD; Stephen E. Jones, MD; Walter H. Harvey, DO; N. Simon Tchekmedyian, MD; Alex Chang, MD; Daniel Galvin, MS; Nan E. Hart, BA, Ondansetron Study Group*
[+] Article and Author Information

From the Mountain States Tumor Institute, Boise, Idaho; Glaxo, Inc. Research Institute, Research Triangle Park, North Carolina; Baylor University Medical Center, Dallas, Texas. Ondansetron Study Group. Requests for Reprints: Thomas M. Beck, MD, Mountain States Tumor Institute, 151 E. Bannock Street, Boise, ID 83712. Grant Support: By Glaxo, Inc. Research Triangle Park, North Carolina.


Copyright ©2004 by the American College of Physicians


Ann Intern Med. 1993;118(6):407-413. doi:10.7326/0003-4819-118-6-199303150-00002
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Objective: To evaluate the efficacy and safety of oral ondansetron (Zofran) as an antiemetic in patients receiving cyclophosphamide-based chemotherapy.

Design: A multicenter, randomized, double-blind, stratified, placebo-controlled trial conducted between March 1989 and January 1990.

Setting: Twenty-seven oncology centers including university hospitals, community cancer centers, and private medical oncology practices.

Patients: A total of 349 chemotherapy-naive patients having their first cycle of cyclophosphamide (≥ 450 mg/m2)-based chemotherapy. Patients also received methotrexate (≥ 30 mg/m2) or doxorubicin (≥ 35 mg/m2). All patients were evaluated for safety and 318 (91%) were evaluated for efficacy.

Interventions: Patients were randomly assigned to one of four treatment groups: placebo, 1 mg, 4 mg, or 8 mg of ondansetron. Assigned study medication was taken three times per day for 3 consecutive days.

Measurements: Time and number of emetic episodes as well as degree of nausea were recorded by patients for each of the 3 study days.

Results: Compared with placebo, all three doses of ondansetron were superior (P < 0.001) in preventing vomiting and controlling nausea. A complete response (no emetic episodes) was observed in 19%, 57%, 65%, and 66% of patients in the placebo, 1-mg, 4-mg, and 8-mg ondansetron groups, respectively. For patients who received higher-dose cyclophosphamide and doxorubicin, a dose-related trend in antiemetic efficacy of ondansetron was observed. Mild headache and constipation were the most frequently reported adverse events. No extrapyramidal reactions were observed.

Conclusion: Oral ondansetron is a safe and effective antiemetic that is more efficacious than placebo for patients receiving cyclophosphamide-based chemotherapy.

* For current author addresses and the members of the study group, see end of text.

Figures

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Figure 1.
Antiemetic treatment response for patients receiving cyclophosphamide (≥ 450 mg/m2).P

Percentages of patients who were considered complete responders (zero emetic episodes) and treatment failures (> 5 emetic episodes or rescued) for each treatment group. values are based on the comparison of the ondansetron group with placebo. Ond = ondansetron.

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Figure 2.
Antiemetic treatment response of patients receiving doxorubicin and cyclophosphamide.P

Percentages of patients who were considered complete responders (zero emetic episodes) and treatment failures (> 5 emetic episodes or rescued) for each treatment group. values are based on the comparison of the ondansetron group with placebo. Ond = ondansetron.

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Figure 3.
Antiemetic treatment response of patients receiving cyclophosphamide (≥ 600 mg/m2).P

Percentages of patients who were considered complete responders (zero emetic episodes) and treatment failures (> 5 emetic episodes or rescued) are shown for each treatment group. values are based on the comparison of the ondansetron group with placebo. Ond = ondansetron.

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Figure 4.
Assessment of nausea in patients.

Median nausea scores at pretreatment and on study days 1 to 3 for patients in each ondansetron group.

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