Survey of chemotherapy-induced nausea and vomiting in patients with urothelial carcinoma

Abstract

Chemotherapy-induced nausea and vomiting (CINV) can cause anorexia, weight loss and deterioration of patient quality of life. It is one of the most unpleasant adverse effects of chemotherapy treatment regimens. For the optimal treatment of gastrointestinal symptoms during urothelial carcinoma chemotherapy, the present study investigated the association between gastrointestinal symptoms and therapeutic effects of gemcitabine plus platinum [cisplatin (GC) or carboplatin (GCa)] therapies. The incidence and frequency of nausea/vomiting with GC split therapy (gemcitabine, 1,000 mg/m² on days 1 and 8; split-dose cisplatin, 35 mg/m² on days 1 and 8; 21-day schedule) and GCa therapy [gemcitabine, 750-1,000 mg/m² on days 1, 8 and 15; carboplatin, area under the blood concentration-time curve=5 mg min/ml (Calvert formula) on day 2; 28-day schedule] were lower compared with those of GC therapy (gemcitabine, 1,000 mg/m² on days 1, 8 and 15; single-dose cisplatin 70 mg/m² on day 2; 28-day schedule). However, no differences in therapeutic outcomes were observed among therapies. GCa therapy, regardless of renal function, and GC split therapy demonstrated significant increases compared with GC therapy in alleviating gastrointestinal symptoms associated with cancer chemotherapy in patients with urothelial carcinoma. Overall, these results suggested that split-dose cisplatin administration or the use of carboplatin instead of cisplatin may be useful in patients who experience CINV without compromising treatment effectiveness.

Keywords: chemotherapy-induced nausea and vomiting; gemcitabine plus carboplatin therapy; gemcitabine plus single-dose cisplatin therapy; gemcitabine plus split-dose cisplatin therapy; urothelial carcinoma.

Figure 1

Number of days with nausea/vomiting per course in the GC, GC split and GCa therapy groups. Mean number of days with (A) nausea and (B) vomiting per course is shown as a scatter plot with mean ± standard error of the mean for the GC therapy group (72 courses), GC split therapy group (23 courses) and GCa therapy group (19 courses). ^*P<0.05, ^**P<0.01 vs. GC therapy group. GC, gemcitabine plus cisplatin; GCa, gemcitabine plus carboplatin.

Figure 2

Prevalence of nausea/vomiting on each treatment day in the GC, GC split and GCa therapy groups. Prevalence of (A) nausea and (B) vomiting between treatment days 1-10 is presented for the GC therapy group (black; 72 courses), GC split therapy group (gray; 23 courses) and GCa therapy group (white; 19 courses). ^*P<0.05, ^**P<0.01 vs. GC therapy group. GC, gemcitabine plus cisplatin; GCa, gemcitabine plus carboplatin.

Figure 3

Use rate of each serotonin 5-HT₃ receptor antagonist in the GC, GC split and the GCa therapy groups. Use rates of ramosetron (diagonal lines), granisetron (gray), and palonosetron (white) are shown for the GC therapy group (72 courses), GC split therapy group (23 courses) and GCa therapy group (19 courses). ^*P<0.05, comparison of the rate of each serotonin 5-HT₃ receptor antagonist; ^#P<0.05, comparison of the rate between the first-generation (ramosetron and granisetron) and the second-generation [serotonin 5-HT₃ receptor antagonist (palonosetron)] vs. GC therapy group. GC, gemcitabine plus cisplatin; GCa, gemcitabine plus carboplatin.

Figure 4

Survival curves for the GC, GC split and GCa therapy groups. Survival rates and duration of survival are shown for the GC therapy group (43 patients), GC split therapy group (9 patients) and GCa therapy group (15 patients). GC, gemcitabine plus cisplatin; GCa, gemcitabine plus carboplatin.