A Comparison of 5-HT3 Receptor Antagonist and Metoclopramide in the Patients Receiving Chemotherapeutic Regimens Including CMF, CAF and CHOP

Background: Chemotherapy- induced nausea and vomiting (CINV) occur frequently causing problems with an unacceptably high incidence that significantly affect patients' daily functioning and health-related quality of life. The present study was aimed to compare acute CINV for granisetron as 5-HT3 receptor antagonist and metoclopramide in the patients receiving chemotherapeutic regimens including cyclophosphamide and adriamycin. An attempt is made to examine whether it is possible to successfully replace granisetron with metoclopramide in control of acute CINV.

Methods: A total of 137 patients with breast cancer (78.8%) and lymphoma (17.5%) from two oncology departments in the first course of chemotherapy were enrolled. They received granisetron 3mg/IV and dexamethasone 8mg for the first referring and in the second referring metoclopramid 30mg/IV and dexamethasone 8mg/IV thirty minutes before chemotherapy and metoclopramide 20mg/IV during chemotherapy. The patients recorded the incidence of chemotherapy induced nausea and vomiting (CINV) and other side effects including headache, extra pyramidal manifestations and delayed nausea.

Results: Median age of studied patients was 49±15 year. The patients who received granisetron and dexamethasone had less acute nausea (during the first 24 hours after chemotherapy) than those who received metoclopramide. Also our study showed that controlled CINV episodes in patients who received CMF regimen were better than the regimen including adriamycin (CAF, CHOP) into both granisetron (p=0.06) and metoclopramid (p=0.04). The most common adverse event related to these drugs was extra pyramidal manifestations for 16 and 10 patients who had received granisetron and metoclopramide respectively. While the number of the patients who had sever delayed CINV (2-7 days after chemotherapy) episodes with granisetron (7 cases) was lower than those who took metoclopramide drug (14 cases). The number of patients who experienced extrapyramidal manifestations in metoclopramide group was lower than granisetron group.

Conclusion: There were not any significant clinically serious adverse events in any patients undergoing chemotherapy due to cancer. Thus, the safety profiles of granisetron and metoclopramide were comparable in this study. The patients who were treated with cyclophosphamide, and adriamycin, the efficacy of dexamethasone and metoclopramide in controlling acute nausea and vomiting nearly equaled to those of granisetron. Thus the present study supports the use of metoclopramide due to its lower cost and nearly the same efficacy and safety compared to granisetron in CMF regimen.