Granisetron vs dolasetron for acute chemotherapy-induced nausea and vomiting (CINV) in high and moderately high emetogenic chemotherapy: an open-label pilot study

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SUMMARYObjective: Comparative studies examining the use of oral serotonin type 3 (5-HT3) receptor antagonists for the management of acute chemotherapy-induced nausea and vomiting (CINV) are limited. Therefore, we performed an experiential open-label pilot study at Stony Brook Hospital to allow clinicians to make informed formulary decisions at our institution and to stimulate further study. Specifically, the objective of this study was to compare the effectiveness of oral granisetron versus oral dolasetron for prophylaxis of acute CINV.Research Design and Methods: The study was conducted during the period of 1 February 2001 to 31 March 2001. Patients (n = 26) with lymphoma or malignancies of the lungs, larynx, or uterus undergoing moderately high and highly emetogenic chemotherapy were studied. Patients admitted during February (n = 13) were administered a single oral dose of 100 mg of dolasetron; those admitted in March (n = 13) received a single oral dose of 2 mg of granisetron. All patients were administered intravenous dexamethasone 20 mg before the initiation of chemotherapy.Main Outcome Measures: Patients were monitored for at least 24 h by clinicians. The data recorded for each patient included age, sex, the number of episodes of nausea and emesis, the intensity of nausea (when applicable), and the number of doses of rescue antiemetic medication administered (when applicable).Results: Overall, granisetron provided significantly greater control of acute CINV than dolasetron. More patients treated with granisetron experienced total control of nausea and vomiting (69.2 vs 23.1%, p < 0.05). Fewer granisetron-treated patients experienced emesis (7.7 vs 53.8%, p < 0.05) and nausea (30.8 vs 76.9%, p < 0.05). Of those patients who experienced nausea, intensity was significantly less with granisetron than with dolasetron ( p < 0.05). Consequently, a significantly greater proportion of patients treated with dolasetron required a rescue antiemetic and significantly more doses of rescue antiemetics (both p < 0.01).Conclusions: These data suggest that oral granisetron may demonstrate improved CINV outcomes compared with oral dolasetron in patients undergoing moderately high and highly emetogenic chemotherapy.