Can the nausea and vomiting from chemotherapy be stopped? Yes it can!

When I was just out of medical school and in my first year of residency, I was assigned to the oncology service. One of the first patients I cared for had Hodgkin disease. Even then, we had pretty good treatment with a drug called nitrogen mustard. It worked well, but caused major nausea and vomiting.

Because of this, patients receiving the drug were admitted to the hospital and sedated while they received their infusion. I remember putting this man to sleep with intravenous seconal, and then giving the nitrogen mustard. He was hard to sedate and needed a lot of seconal. It took at least a day for him to wake up after he received the mustard. Still, it was better than retching for a day.
Later on, when I was working at a county hospital in Los Angeles, we were no longer admitting patients for chemotherapy but giving it to them in the outpatient area. We would give them a drug called compazine, which was next to useless. Another of my Hodgkin disease patients was receiving nitrogen mustard. His strategy was to jump on his motorcycle right after his infusion and race home before the retching began. If there was traffic, everyone suffered.

Then, as I have written earlier in this blog, patients began smoking marijuana, which helped some of them avoid nausea and vomiting from chemotherapy. These were mainly the younger patients. Older ones had trouble with the side effects. Getting high wasn’t a happy experience.

Finally, the drug companies came up with effective nausea-preventing drugs. These are the “trons”, like ondansetron, granisetron, etc. They blocked a certain body chemical called 5 HT and were very effective when they were given along with the chemotherapy. If we had them when my motorcycle guy was getting his drugs, he could ridden home at a much more leisurely pace.

But, by the next day, he might not have felt so well. It turns out that the “trons” are only good for the first day of chemotherapy, while the nausea and vomiting can persist for several days. Giving more of the “trons” doesn’t seem to help. One thing that can help is adding a steroid called dexamethasone to the drug mix on the first day. But still, for many the next few days can be tough.

Now the drug companies have come up with a new class of drugs to prevent nausea and vomiting. These can work for several days. They block another chemical called NK-1. All of these chemicals - 5HT, NK-1 - are made in the brain. It turns out that certain sites in the brain (not the stomach even though it feels like it) are the targets that chemotherapy drugs stimulate to cause nausea and vomiting.

I’m reminded of all this because of a paper published recently in the journal, Lancet Oncology. The researchers tested a new NK-1 blocking drug and found that only one of ten patients given major nausea-causing drugs got sick after their treatment, while one out of four patients who received a placebo developed nausea and vomiting. So we are getting close to almost total prevention of nausea and vomiting. One of these NK-1 drugs (aprepitant Emend) has been around for a couple of years, and now there is one more. We are almost there – no more nausea and vomiting from chemotherapy, and that is a very good thing.

One problem: These drugs cost – a lot – hundreds of dollars per treatment course. But if you ask anyone who has spent several days after their chemotherapy retching into their toilet, they will tell you it is worth it.

Source : www.1800blogger.com