Results of a randomized trial on antiemesis for
cisplatin (CDDP) and non-CDDP
chemotherapy-induced
vomiting are reported. One hundred and sixty-three outpatients received 282
chemotherapy courses (141 with CDDP and 141 without CDDP). Patients were randomly assigned to receive either high-dose
metoclopramide plus
methylprednisolone (arm A) or the same drugs plus
lorazepam (arm B). In both arms a high protection rate for
vomiting was obtained, on the whole without statistically significant differences. Patients who received
lorazepam had, however, significantly fewer
nausea episodes during first day post-
chemotherapy (p less than 0.05). Arm B was also superior in anxiety control during the first day of
chemotherapy (p less than 0.01). Both regimens were significantly more effective in patients who had not been given
chemotherapy previously (p less than 0.01). No differences in
antiemetic protection were found between CDDP and non-CDDP courses. No significant differences were found in premonitory
vomiting control between the two arms of the trial. Toxicity was very mild with both regimens, although sedation was significantly higher in arm B (p less than 0.001). We conclude that high-dose
metoclopramide plus
methylprednisolone is a highly effective combination for
chemotherapy-induced
nausea and
vomiting, and that it is quite suitable for outpatient use.
Lorazepam did not significantly increase the
antiemetic potency of the combination, nor did it improve premonitory
vomiting control, although it gave a better control of acute
nausea and anxiety.