The Antiemetic Effect of Ondansetron in Head and Neck Cancer Patients Receiving Chemotherapy with Cisplatin and 5-Fluorouracil

Cisplatin과 5-Fluorouracil 병합항암요법을 받은 두경부 암환자에서 Ondansetron의 항구토 효과

Background : Cispaltin is highy effective in the treatment of many cancers, but severe nausea and vomiting is main problem. Although high dose metoclopramide effectively prevents cisplatin-induced nausea and vomiting, extrapyramidal symptom frequently occurs. Ondansetron, selective antagonist of 5-HT3 receptor, is a new potent antiemetic without extrapyramidal symptom. Method : We prospectively evaluated the antiemetic effects of ondasetron administered 8 mg 3 times, intravenously during the first 24 hours and orally thereafter until the 6th day in 25 locally advanced hell and neck cancer patients who received cisplatin $100mg/m^2$ on day 1 and 24 hour infusion of 5-fluorouracil $1,000mg/m^2/day$ on days 1 to 5. Results : The rate of nausea control was 56% on day 1. 39.1% on day 2 and 83.4% on days 3 to 6. The rate of vomiting control was 60% on day 1, 47.8% on day 2, and 81.4% on days 3 to 6. In contrast the failure rate was the highest on day 2(26.1%). The adverse effects included headache. general weakness. abdominal pain, dizziness, autophonia. chest discomfurt and mild fever. Conclusion : Ondansetron is moderately effective for the control of nausea and vomiting in acute emesis phase induced by cisplatin but hightly effective in delayed emesis phase. And the failure of control was highest on day 2. The adverse effects were mild and tolerable. The development of new schedule of ondansetron administration is required to achieve better antiemetic effect.

저자들은 국소진행성 두경부암 환자에게 $cisplatin(100mg/m^2,\;day\;1)$과 $5-FU(1,000mg/m^2/day,\;5days)$ 병합투여하는 동안 발생하는 오심과 구토를 조절하는데 ondansetron의 효과와 안전성을 조사하기 위하여 제 1일에 ondansetron 24mg을 정맥투여, 제 2일부터 6일사이에는 8mg씩 1일 3회 경구투여하였다. 1) 오심 조절율은 제 1일 56%, 제 2일 39.1%, 그리고 제 3일부터 6일사이에는 83.4%였다. 2) 구토 조절율은 제 1일 60%, 제 2일 47.8%, 그리고 제 3일부터 6일사이에는 81.4%였다. 구토 조절의 실패율은 제 2일에 26.1%로 가장 높았다. 3) Ondansetron투여중 관찰된 부작용으로는 두통, 전신무력감, 복통, 현훈, 자가강청, 흉부불편감 그리고 경등도 발열등이었다. 이와 같은 결과로 cisplatin 투여시 발생하는 오심과 구토의 조절에 ondansetron이 중등도의 효과를 보이며 비교적 안전하였음을 알 수 있었다.