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conferenceseries

.com

Volume 10

Journal of Carcinogenesis & Mutagenesis: Open Access

Asia Pacific Oncologists & Hospice 2019

May 13-14, 2019

May 13-14, 2019 Singapore

Annual Meeting on

Asia Pacific Oncologists, Hospice and Palliative Care

J Carcinog Mutagen 2019, Volume 10

DOI: 10.4172/2157-2518-C1-006

Antiemetic prophylaxis for Temozolomide: Monotherapy vs. combination?

Mridul Malhotra

India

Introduction:

Temozolomide>75 mg/m

has moderate emetogenic potential and 5HT3 antagonist monotherapy is

recommended as antiemetic prophylaxis. However, NCCN, ESMO and other international guidelines recommend multi-drug

combinations for intravenous chemotherapy of moderate emetogenicity but antiemetic prophylaxis for oral chemotherapeutic

agents is not well defined. Further Temozolomide has potential for causing delayed emesis. We hypothesize the need for

combination antiemetic prophylaxis for adjuvant Temozolomide and compared 5HT3 antagonist monotherapy with

combination regimens.

Methods:

We maintain a prospective chemotherapy database of patients diagnosed with central nervous system tumors. This

database was used for selection of cases for the current practice audit. Patients included in study were receiving adjuvant

Temozolomide for gliomas from October 2017 to June 2018. Antiemetic prophylaxis was administered for five days along

with Temozolomide (150–200 mg/m

) under three subsets: Ondansetron 8 mg BD, Ondansetron 8 mg BD+Domperidone

10 mg BD and Ondansetron 8 mg BD+Olanzapine 5 mg BD. CINV (graded as per CTCAE 4.03) was defined as either nausea

or vomiting occurring within 120 hours of last dose of TMZ. Statistical Analysis was performed using SPSS version 20 and R

Studio version 1.1.456. The CINV, nausea, vomiting were compared using chi-square test with Bonferroni correction. A p value

of below 0.025 was considered significant.

Results:

360 patients were selected with 91 (25.3%), 113 (31.4%) and 156 (43.3%) patients in Ondansetron,

Ondansetron+Domperidone and Ondansetron+Olanzapine group respectively. The overall incidence of CINV, nausea and

Vomiting was 25.0% (n=90), 25.0% (n=90) and 7.2% (n=26) respectively. The incidence of ≥Grade 2 nausea [17(18.7%),

13(11.5%) and 10(6.4%) p:0.012] and ≥Grade 2 vomiting [5(5.5%), 5(5.3%) and 0; p:0.015] was reduced with combination

antiemetic regimes which was statistically significant. Olanzapine+Ondansetron were most efficacious antiemetic prophylactic

combination.

Conclusions:

TheCINVrates withTemozolomide at 150-200mg/m

are highwithOndansetronmonotherapy.The combination

of Ondansetron with Olanzapine leads to statistically significant decrease in the rate of moderate to severe emesis and nausea

and offers a cost effective steroid sparing antiemetic regimen.