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Tropisetron versus Metoclopramide in the Control of Emesis in Far-Advanced Cancer

Cancer Pain Relief and Palliative Care Unit, University of Athens, Areteion Hospital, Athens, Greece

Correspondence: Kyriaki Mystakidou, M.D., Ph.D., Cancer Pain Relief and Palliative Care Unit, University of Athens, Areteion Hospital, Vas. Sofias 76, 11528 Athens, Greece. Telephone: 30-1-94-334330; Fax: 30-1-7286248.

The present study was conducted to assess the optimum treatment for nausea and vomiting in patients with far advanced cancer. More specifically, we studied patients with cancers that were too far advanced to benefit from chemotherapy or radiotherapy and whose nausea and vomiting were not due to drug intake, cranial, electrolytic, or metabolic causes. One hundred twenty patients who were under antiemetic medication with metoclopramide (MET) and suddenly presented with uncontrolled nausea and vomiting were randomized to three different therapeutic regimens: MET plus dexamethasone (DEX), MET plus tropisetron (TRO), and MET plus TRO plus DEX. Patient diary cards were used to assess nausea and vomiting. By the end of day 15, total control of vomiting was achieved in 24% of MET plus DEX patients, in 84% of MET plus TRO patients, and in 92% of MET plus TRO plus DEX patients. Total control of nausea was achieved in 18% of MET plus DEX patients, in 74% of MET plus TRO patients, and in 87% of MET plus TRO plus DEX patients. All antiemetic treatments were similarly well tolerated. TRO in combination with either MET or MET and DEX produced the best control of both nausea and vomiting.

Key Words. Far advanced cancer • Emesis • Nausea • Vomiting • Tropisetron • Metoclopramide