Granisetron, tropisetron, and ondansetron in the prevention of acute emesis induced by a combination of cisplatin-Adriamycin and by high-dose ifosfamide delivered in multiple-day continuous infusions

The antiemetic efficacy of granisetron, ondansetron and tropisetron was evaluated in patients treated with cisplatin-Adriamycin (CDP/ADM) and ifosfamide (IFO) by continuous infusion (CI). In all, 90 patients with osteosarcoma were randomly assigned to receive granisetron (2 mg/m(2)), or on dansetron (5.3 mg/m(2)), or tropisetron (3.3 mg/m(2)) plus dexamethasone 8 mg/m(2). Chemotherapy consisted of CDP (120 mg/m(2), 48-h CI) followed by ADM (75 mg/m(2), 24-h CI) and then, in the second cycle, delivered 3 weeks later, IFO 15 g/m(2) (120-h CI). Complete protection (CP) from emesis was obtained on 59% of the 717 days of treatment, without significant differences among the three study drugs. A significantly higher rate of CP was obtained during chemotherapy with IFO than with CDP/ADM (69% vs 43%; P < 0.0001). The rate of CP declined from the first to the last day of treatment for both CDP/ADM (61% to 27%, P < 0.0001) and IFO (95% to 43%) cycles (P < 0.0001). When CDP/ADM and IFO are delivered on multiple days by CI, granisetron, ondansetron and tropisetron have the same antiemetic efficacy, which declines from the first day onward through successive days.