effects of chemotherapy

Table 19.1. The most dramatic improvement in the management of side effects was with the development of the 5-hydroxytryptamine antagonist antiemetics. More recently the Neurokinin-1 antagonist aprepitant has improved the emesis of patients undergoing cisplatin based chemotherapy. Typical antiemetic regimens are shown in Table 19.2. Other drugs that have improved drug delivery have been the recombinant growth factors for red (erythropoietin) and white cells (human granulocyte colony-stimulating factor (G-CSF)). These agents stimulate the release of progenitor cells from the bone marrow and are useful in the treatment and prevention of anaemia and neutropenia.

Table 19.1 Side effects of treatment

Table 19.2 Typical antiemetic regimens

Grade of emesis	Antiemetic protocol
Low	Metoclopramide 20 mg IV if required Metoclopramide 10–20 mg orally (PO) tds PRN
Moderate	5HT₃ antagonist PO and dexamethasone 8 mg PO then Metoclopramide 20 mg tds Dexamethasone 4 mg bd Both for 3 days
High	5HT₃ antagonist PO and dexamethasone 8 mg PO then 5HT₃ antagonist PO for 1 day Dexamethasone 4 mg bd for 3 days Metoclopramide 20 mg tds PRN

Second-line antiemetics
Acute emesis	Give the antiemetic protocol for next grade of emesis
If already at ‘high’ give metoclopramide regularly, consider alternative antiemetics	Add in aprepitant 125 mg PO pre chemotherapy and 80 mg PO for 2 days post chemotherapy
Delayed emesis (>24 hours post chemotherapy)	Consider lengthening course of steroids, add in aprepitant and consider alternative antiemetics
Anxiety component	Add Lorazepam 1 mg PO or sublingually tds PRN. This can be started 1–2 days prior to chemotherapy
Alternative antiemetics	Domperidone rectally 30–60 mg 4–8 hourly PRN Haloperidol 1.5 mg tds PRN Cyclizine 50 mg tds PRN or regularly or levomepromazine 6 mg qds PRN