Benefits and adverse effects of anti-emetic glucocorticoids in cancer.

摘要

One of the most common and severe adverse effects of cytostatic treatment is the occurrence of nausea and emesis. After administration of highly emetic organoplatinum compounds for example, the enterochromaffin cells of the intestinal mucosa release excessive amounts of intracellular stored serotonin (5 hydroxytryptamine, 5 HT) granules.1 Subsequendy, the released serotonin stimulates the 5 HT_3 receptors on adjacent abdominal vagal nerves resulting in the activation of the brainstem's vomiting center.' In addition, serotonin shed into the blood circulation by mucosa cells can activate the chemoreceptor trigger zone (CTZ), a chemoreceptor complex of the brain which is not restricted by the serotonin impassable blood brain barrier but communicates closely with the brainstem's vomiting center. Thus, agents which inhibit the production or action of serotonin are among the most effective ami emetic drugs. Clinically, the most widespread and convenient first line anti emetic treatment comprises application of a 5 HT, receptor antagonist (e.g., ondansetron) combined with the synthetic glucocorticoid dexamethasone.2'3 Patients receiving ondansetron in combination with dexamethasone revealed a higher anti emetic response than patients receiving ondansetron alone.