Skip to main content

Advertisement

Log in

Granisetron in the control of radiotherapy-induced nausea and vomiting: a comparison with other antiemetic therapies

  • Review Article
  • Published:
Supportive Care in Cancer Aims and scope Submit manuscript

Abstract

Radiotherapy-induced nausea and vomiting (RINV) can be one of the most distressing symptoms of radiotherapy treatment, which if incompletely controlled may last for several weeks with fractionated radiotherapy and prevent completion of the planned treatment course. Current treatment guidelines recommend the use of 5-HT3 receptor antagonists with or without corticosteroids for highly and moderately emetogenic radiotherapy, though only granisetron and ondansetron are currently indicated for RINV in most countries. Granisetron is a potent and highly selective 5-HT3 receptor antagonist, with demonstrated efficacy in RINV in both placebo-controlled and comparative studies. In this paper the clinical experience with granisetron in RINV is reviewed, and its efficacy and safety compared with other antiemetic therapies.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Aapro M, Bourke JP (2003) Rapid intravenous administration of granisetron prior to chemotherapy is not arrhythmogenic: results of a pilot study. Eur J Cancer 39:927–931

    PubMed  Google Scholar 

  2. Aass N, Hatun DE, Thoresen M, Fossa SD (1997) Prophylactic use of tropisetron or metoclopramide during adjuvant abdominal radiotherapy of seminoma stage I: a randomised, open trial in 23 patients. Radiother Oncol 45:125–128

    PubMed  Google Scholar 

  3. Abbott B, Ippoliti C, Bruton J, Neumann J, Whaley R, Champlin R (1999) Antiemetic efficacy of granisetron plus dexamethasone in bone marrow transplant patients receiving chemotherapy and total body irradiation. Bone Marrow Transplant 23:265–269

    PubMed  Google Scholar 

  4. Abbott B, Ippoliti C, Hecth D, Bruton J, Whaley B, Champlin R (2000) Granisetron (Kytril) plus dexamethasone for antiemetic control in bone marrow transplant patients receiving highly emetogenic chemotherapy with or without total body irradiation. Bone Marrow Transplant 25:1279–1283

    PubMed  Google Scholar 

  5. Belkacemi Y, Ozsahin M, Pene F, et al (1996) Total body irradiation prior to bone marrow transplantation: efficacy and safety of granisetron in the prophylaxis and control of radiation-induced emesis. Int J Radiat Oncol Biol Phys 36:77–82

    PubMed  Google Scholar 

  6. Bey P, Wilkinson PM, Resbeut M, et al (1996) A double-blind, placebo-controlled trial of i.v. dolasetron mesilate in the prevention of radiotherapy-induced nausea and vomiting in cancer patients. Support Care Cancer 4:378–383

    PubMed  Google Scholar 

  7. Bloomer JC, Baldwin SJ, Smith GJ, et al (1994) Characterisation of the cytochrome P450 enzymes involved in the in vitro metabolism of granisetron. Br J Clin Pharmacol 38:557–566

    PubMed  Google Scholar 

  8. Blower PR (1995) A pharmacologic profile of oral granisetron (Kytril tablets). Semin Oncol 22 [Suppl 10]:3–5

    Google Scholar 

  9. Blower PR (2002) 5-HT3-receptor antagonists and the cytochrome P450 system: clinical implications. Cancer J 8:405–414

    PubMed  Google Scholar 

  10. Blower P (2003) Granisetron: relating pharmacology to clinical efficacy. Support Care Cancer 11:93–100

    PubMed  Google Scholar 

  11. Cowan JD, Neidhart J, McClure S, et al (1991) Randomized trial of doxorubicin, bisantrene, and mitoxantrone in advanced breast cancer: a Southwest Oncology Group study. J Natl Cancer Inst 83:1077–1084

    PubMed  Google Scholar 

  12. Davis MP, Homsi J (2001) The importance of cytochrome P450 monooxygenase CYP2D6 in palliative medicine. Support Care Cancer 9:442–451

    PubMed  Google Scholar 

  13. Dixon CM, Colthup PV, Serabjit-Singh CJ, et al (1995) Multiple forms of cytochrome P450 are involved in the metabolism of ondansetron in humans. Drug Metab Dispos 23:1225–1230

    PubMed  Google Scholar 

  14. Extermann M (2000) Assessment of the older cancer patient. Hematol Oncol Clin North Am 14:63–77

    PubMed  Google Scholar 

  15. Fauser AA, Russ W, Bischoff M (1997) Oral dolasetron mesilate (MDL 73,147EF) for the control of emesis during fractionated total-body irradiation and high-dose cyclophosphamide in patients undergoing allogeneic bone marrow transplantation. Support Care Cancer 5:219–222

    PubMed  Google Scholar 

  16. Feyer PC, Stewart AL, Titlbach OJ (1998) Aetiology and prevention of emesis induced by radiotherapy. Support Cancer Care 6:253–260

    Google Scholar 

  17. Freeman AJ, Cunningham KT, Tyers MB (1992) Selectivity of 5-HT3 receptor antagonists and anti-emetic mechanisms of action. Anticancer Drugs 3:79–85

    PubMed  Google Scholar 

  18. Franzen L, Nyman J, Hagberg H, et al (1996) A randomized placebo controlled study with ondansetron in patients undergoing fractionated radiotherapy. Ann Oncol 7:587–592

    PubMed  Google Scholar 

  19. Gregory RE, Ettinger DS (1998) 5-HT3 receptor antagonists for the prevention of chemotherapy-induced nausea and vomiting. A comparison of their pharmacology and clinical efficacy. Drugs 55:173–189

    PubMed  Google Scholar 

  20. Goldberg RM, Mabee J, Chan L, Wong S (1996) Drug–drug interactions in the elderly: analysis of a high risk population. Am J Emerg Med 14:447–450

    PubMed  Google Scholar 

  21. Goshman L, Fish J, Roller K (1999) Clinically significant cytochrome P450 drug interactions. J Pharm Soc Wis 23–38

  22. The Italian Group for Antiemetic Research in Radiotherapy (1999) Radiation-induced emesis: a prospective observational multicenter Italian trial. Int J Radiat Oncol Biol Phys 44:619–625

    Google Scholar 

  23. Kaiser R, Sezer O, Papies A, et al (2002) Patient-tailored antiemetic treatment with 5-hydroxytryptamine type 3 receptor antagonists according to cytochrome P-450 2D6 genotypes. J Clin Oncol 20:2805–2811

    PubMed  Google Scholar 

  24. Kenney WL, Chiu P (2001) Influence of age on thirst and fluid intake. Med Sci Sports Exerc 33:1524–1532

    PubMed  Google Scholar 

  25. Krengli M, Lazzari R, Manara M (1996) Use of orally administered granisetron in radiotherapy-induced emesis (in Italian). Minerva Med 87:605–608

    PubMed  Google Scholar 

  26. Lanciano R, Sherman DM, Michalski J, Preston AJ, Yocom K, Friedman C (2001) The efficacy and safety of once-daily Kytril (granisetron hydrochloride) tablets in the prophylaxis of nausea and emesis following fractionated upper abdominal radiotherapy. Cancer Invest 19:763–772

    PubMed  Google Scholar 

  27. LeBourgeois JP, McKenna CJ, Coster B, et al (1999) Efficacy of ondansetron orally disintegrating tablet: a novel oral formulation of this 5-HT3 receptor antagonist in the treatment of fractionated radiotherapy-induced nausea and emesis. Clin Oncol 11:340–347

    Google Scholar 

  28. Lindley C, Blower P (2000) Oral serotonin type 3-receptor antagonists for prevention of chemotherapy-induced emesis. Am J Health Syst Pharm 57:1685–1697

    PubMed  Google Scholar 

  29. Logue JP, Magee B, Hunter RD, Murdoch RD (1991) The antiemetic effect of granisetron in lower hemibody radiotherapy. Clin Oncol 3:247–249

    Google Scholar 

  30. MASCC Consensus conference on antiemetic therapy, Perugia, 29–31 March 2004. Available at www.mascc.org. Accessed July 2004

  31. Maisano R, Pergolizzi S, Settineri N (1998) Escalating dose of oral ondansetron in the prevention of radiation induced emesis. Anticancer Res 18:2011–2013

    PubMed  Google Scholar 

  32. Miralbell R, Coucke P Behrouz F, et al (1995) Nausea and vomiting in fractionated radiotherapy: a prospective on-demand trial of tropisetron rescue for non-responders to metoclopramide. Eur J Cancer 31A:1461–1464

    PubMed  Google Scholar 

  33. Okamoto S, Takahashi S, Tanosaki R, et al (1996) Granisetron in the prevention of vomiting induced by conditioning for stem cell transplantation: a prospective randomised study. Bone Marrow Transplant 17:679–683

    PubMed  Google Scholar 

  34. Orchard PJ, Rogosheske J, Burns L, et al (1999) A prospective randomised trial of the anti-emetic efficacy of ondansetron and granisetron during bone marrow transplantation. Biol Blood Marrow Transplant 5:386–393

    PubMed  Google Scholar 

  35. Palmer R (1994) Efficacy and safety of granisetron (Kytril) in two special patient populations: children and adults with impaired hepatic function. Semin Oncol 21 [Suppl 5]:22–25

    PubMed  Google Scholar 

  36. Perez EA, Hesketh P, Sandbach J, et al (1998) Comparison of single-dose oral granisetron versus intravenous ondansetron in the prevention of nausea and vomiting induced by moderately emetogenic chemotherapy: a multicenter, double-blind, randomized parallel study. J Clin Oncol 16:754–760

    PubMed  Google Scholar 

  37. Perez EA, Lembersky B, Kaywin P, Kalman L, Yocom K, Friedman C (1998) Comparable safety and antiemetic efficacy of a brief (30-second bolus) intravenous granisetron infusion and a standard (15-minute) intravenous ondansetron infusion in breast cancer patients receiving moderately emetogenic chemotherapy. Cancer J Sci Am 4:52–58

    PubMed  Google Scholar 

  38. Prentice HG, Cunningham S, Gandhi L, Cunningham J, Collis C, Hamon MD (1995) Granisetron in the prevention of irradiation-induced emesis. Bone Marrow Transplant 15:445–448

    PubMed  Google Scholar 

  39. Priestman TJ, Roberts JT, Upadhyaya BK (1993) A prospective randomized double-blind trial comparing ondansetron versus prochlorperazine for the prevention of nausea and vomiting in patients undergoing fractionated radiotherapy. Clin Oncol (R Coll Radiol) 5:358–363

    Google Scholar 

  40. Priestman TJ, Roberts JT, Lucraft H, Collis CH, Adams M, Upadhyaya BK, Priestman S (1990) Results of a randomized, double-blind comparative study of ondansetron and metoclopramide in the prevention of nausea and vomiting following high-dose upper abdominal irradiation. Clin Oncol (R Coll Radiol) 2:71–75

    Google Scholar 

  41. Rapoport AP, Meisenberg B, Sarkodee-Adoo C, et al (2002) Autotransplantation for advanced lymphoma and Hodgkin’s disease by post-transplant rituxan/GM-CSF or radiotherapy and consolidation chemotherapy. Bone Marrow Transplant 29:303–312

    PubMed  Google Scholar 

  42. Reske SN, Bunjes D, Bucmann I, et al (2001) Targeted bone marrow irradiation in the conditioning of high-risk leukaemia prior to stem cell transplantation. Eur J Nucl Med 28:807–815

    PubMed  Google Scholar 

  43. Roberts JT, Priestman TJ (1993) A review of ondansetron in the management of radiotherapy-induced emesis. Oncology 50:173–179

    PubMed  Google Scholar 

  44. Roila F, Ciccarese G, Palladino MA, De Angelis V (1998 ) Prevention of radiotherapy-induced emesis. Tumori 84:274–278

    PubMed  Google Scholar 

  45. Rutqvist LE, Lax I, Fornander T, Johansson H (1992) Cardiovascular mortality in a randomized trial of adjuvant radiation therapy versus surgery alone in primary breast cancer. Int J Radiat Oncol Biol Phys 22:1157–1158

    PubMed  Google Scholar 

  46. Sanwald P, David M, Dow J (1996) Characterization of the cytochrome P450 enzymes involved in the in vitro metabolism of dolasetron. Comparison with other indole-containing 5-HT3 antagonists. Drug Metab Dispos 14:602–609

    Google Scholar 

  47. Scarantino CW, Ornitz RO, Hoffman LG, Anderson RF (1994) On the mechanism of radiation-induced emesis: the role of serotonin. Int J Radiat Oncol Biol Phys 30:825–830

    PubMed  Google Scholar 

  48. Schwella N, Konig V, Schwerdtfeger R, et al (1994) Ondansetron for efficient emesis control during total body irradiation. Bone Marrow Transplant 13:169–171

    PubMed  Google Scholar 

  49. Seegenschmiedt MH (2001) Qualitätsmanagement in der radiookolgie. Onkologe 6:291–306

    Google Scholar 

  50. Spitzer TR, Bryson JC, Cirenza E, et al (1994) Randomised double-blind placebo-controlled evaluation of oral ondansetron in the prevention of nausea and vomiting associated with fractionated total-body irradiation. J Clin Oncol 12:2432–2438

    PubMed  Google Scholar 

  51. Spitzer TR, Friedman CJ, Bushnell W, Frankel SR, Raschko J (2000) Double-blind randomised, parallel-group study on the efficacy and safety of oral granisetron and oral ondansetron in the prophylaxis of nausea and vomiting in patients receiving hyperfractionated total body irradiation. Bone Marrow Transplant 26:203–210

    PubMed  Google Scholar 

  52. Sykes AJ, Kiltie AE, Stewart AL (1997) Ondansetron versus a chlorpromazine and dexamethasone combination for the prevention of nausea and vomiting: a prospective, randomised study to assess efficacy, cost effectiveness and quality of life following single-fraction radiotherapy. Support Care Cancer 5:500–503

    PubMed  Google Scholar 

  53. Van Wijngaarden I, Tulp MT, Soudijn W (1990) The concept of selectivity in 5-HT receptor research. Eur J Pharmacol 138:301–302

    Google Scholar 

  54. Yancik R, Ries LAG (2000) Aging and cancer in America. Hematol Oncol Clin North Am 14:17–23

    PubMed  Google Scholar 

Download references

Acknowledgements

This paper was supported by Hoffmann-La Roche.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Petra Feyer.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Feyer, P., Seegenschmiedt, M.H. & Steingraeber, M. Granisetron in the control of radiotherapy-induced nausea and vomiting: a comparison with other antiemetic therapies. Support Care Cancer 13, 671–678 (2005). https://doi.org/10.1007/s00520-004-0766-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00520-004-0766-3

Keywords

Navigation