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Paul J Hesketh - One of the best experts on this subject based on the ideXlab platform.
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Antiemetics: ASCO Guideline Update.
Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2020Co-Authors: Paul J Hesketh, Rebecca A. Clark-snow, Mark G. Kris, Ethan Basch, Kari Bohlke, Sally Y. Barbour, Michael A. Danso, Kristopher Dennis, L. Lee Dupuis, Stacie B. DusetzinaAbstract:PURPOSETo update the guideline to include new anticancer agents, Antiemetics, and Antiemetic regimens and to provide recommendations on the use of dexamethasone as a prophylactic Antiemetic in pati...
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Antiemetics american society of clinical oncology clinical practice guideline update
Journal of Oncology Practice, 2011Co-Authors: Ethan Basch, Mark G. Kris, Paul J Hesketh, Ann Alexis Prestrud, Sarah Temin, Gary H LymanAbstract:ASCO's update to its Antiemetics guideline now includes an evaluation of evidence on complementary Antiemetic therapy.
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drug insight new Antiemetics in the management of chemotherapy induced nausea and vomiting
Nature Reviews Clinical Oncology, 2005Co-Authors: Paul J HeskethAbstract:Recent improvements in the development of Antiemetics have helped to minimize chemotherapy-induced nausea and vomiting. Oo and Hesketh review the latest clinical trial data and discuss how the introduction of two new Antiemetics, palonosetron, a 5-HT3 antagonist, and aprepitant, a NK-1 antagonist, have demonstrated significant advances for patients inadequately controlled with conventional Antiemetic regimens. Nausea and vomiting remain among the most feared side effects of chemotherapy for cancer patients. Significant progress has been made in the last 15 years in developing more effective and better-tolerated measures to minimize chemotherapy-induced nausea and vomiting (CINV). During the 1990s, the selective 5-hydroxytryptamine receptor antagonists were first introduced for the treatment of CINV, and resulted in more effective and better tolerated treatment of CINV. Despite recent progress, however, a significant number of patients still develop CINV, particularly during the 2–5 day period (delayed emesis) following chemotherapy. There is evidence that this may be an underappreciated problem on the part of some caregivers. Recently, two new Antiemetics, aprepitant, the first member of the neurokinin-1 antagonists, and palonosetron, a second-generation 5-hydroxytryptamine receptor antagonist, received regulatory approval in the US. Both represent useful additions to the therapeutic armamentarium for the management of CINV.
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control of high dose cisplatin induced emesis with an all oral three drug Antiemetic regimen
Supportive Care in Cancer, 2000Co-Authors: Paul J Hesketh, Angelie Roman, Ann M Hesketh, Edith A Perez, Martin J Edelman, David R GandaraAbstract:In this pilot trial, the Antiemetic efficacy and tolerability of an all-oral Antiemetic combination in the prevention of both acute and delayed nausea and vomiting following high-dose cisplatin was evaluated. Fifty-two patients receiving cisplatin (median dose 100 mg/m2) were entered. Patients received (1) 60 min prior to cisplatin: prochlorperazine spansule 15 mg, dexamethasone 20 mg, granisetron 2 mg; (2) 12 h after cisplatin: prochlorperazine spansule 15 mg, dexamethasone 10 mg; (3) on days 2 and 3: prochlorperazine spansule 15 mg b.i.d., dexamethasone 8 mg b.i.d.; (4) on days 4 and 5: dexamethasone 4 mg b.i.d. All Antiemetics were administered orally. The study period was the 120 h after cisplatin administration. The primary efficacy end-point was complete control (no vomiting, retching or Antiemetic rescue) of delayed emesis (24–120 h after cisplatin). Complete control of delayed emesis was achieved in 26 patients (53%). Nineteen patients (39%) noted no delayed nausea. Complete control of acute emesis (24 h after cisplatin) was attained in 44 patients (86%). The no nausea rate during the first 24 h was 74%. Overall, 39 patients (80%) were satisfied or very satisfied with their outcome. Treatment was well tolerated with infrequent and minor adverse events. In conclusion, an all-oral combination of granisetron, dexamethasone and prochlorperazine is a highly effective and well-tolerated regimen for preventing acute cisplatin-induced emesis. Control of delayed emesis was not better than with current standard treatment, and more effective approaches are needed.
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improved control of high dose cisplatin induced acute emesis with the addition of prochlorperazine to granisetron dexamethasone
The cancer journal from Scientific American, 1997Co-Authors: Paul J Hesketh, David R Gandara, Ann M Hesketh, Martin J Edelman, Lauri M Webber, Matthew Mcmanus, John D HainsworthAbstract:PURPOSE To evaluate the Antiemetic efficacy and safety of adding the dopamine antagonist prochlorperazine to the combination of granisetron and dexamethasone in the prevention of acute nausea and vomiting following high-dose cisplatin. PATIENTS AND METHODS Sixty patients receiving cisplatin (> or = 75 mg/m2) (median dose = 100 mg/m2) were enrolled at three sites. Patients received prochlorperazine spansule 15 mg orally, 60 minutes prior to and 12 hours after cisplatin; dexamethasone 20 mg intravenously, 45 minutes prior to cisplatin, and 10 mg intravenously or orally, 12 hours after cisplatin; and granisetron 10 micrograms/kg intravenously, 30 minutes prior to cisplatin. Efficacy was assessed during the 24-hour period after cisplatin using complete Antiemetic response (no emetic episodes and no rescue Antiemetics) and patient assessment of nausea and satisfaction using 100-mm visual analog scales (nausea: 0 = none, 100 = nausea as bad as it can be; satisfaction: 0 = not at all satisfied, 100 = satisfied as can be). RESULTS Complete response (0 emetic episodes) was noted in 84% (49/58) of patients. Forty-two patients (72%) experienced no nausea. The mean change in posttreatment nausea visual analog scales from baseline was 8.9 mm. Forty-eight patients (83%) were completely satisfied with their Antiemetic treatment. The mean posttreatment patient satisfaction score was 92 mm. Treatment was well tolerated, with infrequent and minor adverse events. CONCLUSIONS This three-drug Antiemetic regimen is well tolerated and highly effective in the prevention of acute nausea and vomiting arising from high-dose cisplatin. Further studies evaluating this regimen are warranted.
Paul F. White - One of the best experts on this subject based on the ideXlab platform.
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an update on the management of postoperative nausea and vomiting
Journal of Anesthesia, 2017Co-Authors: Xuezhao Cao, Paul F. WhiteAbstract:Postoperative nausea and vomiting (PONV) and postdischarge nausea and vomiting (PDNV) remain common and distressing complications following surgery. PONV and PDNV can delay discharge and recovery and increase medical costs. The high incidence of PONV has persisted in part because of the tremendous growth in ambulatory surgery and the increased emphasis on earlier mobilization and discharge after both minor and major operations. Pharmacological management of PONV should be tailored to the patients’ risk level using the PONV and PDNV scoring systems to minimize the potential for these adverse side effects in the postoperative period. A combination of prophylactic Antiemetic drugs should be administered to patients with moderate-to-high risk of developing PONV in order to facilitate the recovery process. Optimal management of perioperative pain using opioid-sparing multimodal analgesic techniques and preventing PONV using prophylactic Antiemetics are key elements for achieving an enhanced recovery after surgery. Strategies that include reductions of the baseline risk (e.g., adequate hydration, use of opioid-sparing analgesic techniques) as well as a multimodal Antiemetic regimen will improve the likelihood of preventing both PONV and PDNV.
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the impact of current Antiemetic practices on patient outcomes a prospective study on high risk patients
Anesthesia & Analgesia, 2008Co-Authors: Paul F. White, Charles R Roberson, Jerome F Ohara, Ronald H Wender, Keith A CandiottiAbstract:BACKGROUND: In this prospective, multicenter, observational study, we evaluated the incidence and time course of postoperative nausea and vomiting (PONV), assessed prophylactic and rescue Antiemetic use in high-risk patients, and determined population-based effectiveness of Antiemetics, including the impact of American Society of Anesthesiologists (ASA) and American Society of Perianesthesia Nurses (ASPAN) guideline compliance. METHODS: Eligible patients undergoing elective laparoscopic or major plastic surgery possessed two or more of the following Apfel PONV risk factors: female gender, history of PONV or motion sickness, and nonsmoking status. Antiemetic use, emetic episodes, severity of nausea, and functional interference due to PONV were documented during the first 72 h after surgery. Complete response (CR) was defined as no emesis or rescue medication use, and complete control was defined as CR and no moderate-severe nausea. The effect of compliance (versus noncompliance) with ASA and ASPAN guidelines on PONV outcomes was also analyzed. RESULTS: The proportion of patients experiencing postoperative emesis ranged from 18% to 40% depending on the number of Antiemetics administered. The rate of rescue medication (45%) was similar to the reported incidences of moderate-to-severe nausea (47%) and functional interference due to emetic symptoms (44%). The administration of three or more Antiemetics produced better patient outcomes overall compared to <1 prophylactic Antiemetic. CR rates were <70% despite adherence to current organizational PONV management guidelines (ASA: 69%; ASPAN: 63%). The complete control rates were 10% lower than CR rates over the 3 day study period. CONCLUSIONS: Administration of three or more prophylactic Antiemetics had the most positive impact on emetic outcomes over 72 hrs in patients at risk of developing PONV. Although compliance with organizational PONV management guidelines improved patient outcomes, postoperative emetic symptoms and interference with patient functioning still occurred in more than 30% of these high-risk patients.
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the use of oral granisetron versus intravenous ondansetron for Antiemetic prophylaxis in patients undergoing laparoscopic surgery the effect on emetic symptoms and quality of recovery
Anesthesia & Analgesia, 2006Co-Authors: Paul F. White, Ronald H Wender, Jun Tang, Mohamed A Hamza, Babatunde O Ogunnaike, Robert Naruse, Alexander Sloninsky, Robert Kariger, Scott A CunneenAbstract:Based on comparative studies in patients receiving emetogenic chemotherapy, it has been suggested that granisetron would be more effective than ondansetron for the prevention of postdischarge nausea and vomiting (PDNV). However, there have been no direct comparisons of these two popular 5-HT3 antagonists with respect to PDNV and quality of recovery. We designed this randomized, double-blind study to compare the Antiemetic efficacy of oral granisetron (1 mg) to a standard IV dose of ondansetron (4 mg) when administered for Antiemetic prophylaxis as part of a multimodal regimen in a laparoscopic surgical population. A total of 220 patients undergoing laparoscopic surgery with a standardized general anesthetic technique were enrolled in this prospective study at two major medical centers. Patients were randomly assigned to one of two prophylactic treatment groups: the control (ondansetron) group received an oral placebo 1 h before surgery and ondansetron, 4 mg IV, at the end of the surgery, and the granisetron group received granisetron, 1 mg per os, 1 h before surgery, and normal saline, 2 mL IV, at the end of the surgery. The early recovery profiles, requirement for rescue Antiemetics, incidence of PDNV, and the side effects were recorded over the 48 h study period. In addition, nausea scores were assessed using an 11-point verbal rating scale at specific intervals in the postoperative period. The quality of recovery and patient satisfaction scores were recorded at 48 h after surgery. The demographic characteristics were similar in the two prophylaxis treatment groups, as well as the recovery times to patient orientation, oral intake, and hospital discharge. The incidences of PDNV, requirements for rescue Antiemetics, and quality of recovery did not differ between the two study groups. The Antiemetic drug acquisition costs to achieve comparable patient satisfaction with ondansetron and granisetron were US $25.65 and $47.05, respectively. Therefore, ondansetron (4 mg IV) was more cost-effective than granisetron (1 mg per os) for routine Antiemetic prophylaxis as part of a multimodal regimen in patients undergoing either outpatient or inpatient laparoscopic surgery.
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prevention of postoperative nausea and vomiting a multimodal solution to a persistent problem
The New England Journal of Medicine, 2004Co-Authors: Paul F. WhiteAbstract:Despite the introduction of new Antiemetic agents, short-acting anesthetics, and minimally invasive surgical techniques, the incidence of postoperative nausea and vomiting has remained largely unchanged over the past two decades.1 The high incidence of postoperative nausea and vomiting has persisted in part because of the tremendous growth in ambulatory surgery and the increased emphasis on earlier mobilization and discharge after both minor and major operations. Prophylactic use of Antiemetics has become the standard approach to minimizing emetic symptoms after surgery because patients are more satisfied with this approach than with the treatment of symptoms when they occur in the postoperative . . .
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comparative efficacy of acustimulation reliefband versus ondansetron zofran in combination with droperidol for preventing nausea and vomiting
Anesthesiology, 2002Co-Authors: Paul F. White, Tijani Issioui, Stephanie B Jones, Jayne E Coleman, Jean P Waddle, Scott D Markowitz, Margarita Coloma, Amy R Macaluso, Caleb IngAbstract:Background Antiemetic drugs are costly, are associated with variable efficacy, and can produce unwanted side effects when used for prophylaxis against postoperative nausea and vomiting. This clinical study was designed to compare the efficacy of transcutaneous electrical acupoint stimulation using a ReliefBand® to ondansetron (Zofran®) when utilized alone or in combination for preventing postoperative nausea and vomiting after plastic surgery. Methods A single-center, randomized, double-blind, placebo- and sham-controlled study design was conducted to compare three prophylactic Antiemetic treatment regimens in 120 outpatients undergoing plastic surgery procedures with routine low-dose droperidol prophylaxis: (1) ondansetron (n = 40), 4 mg intravenous ondansetron and a sham ReliefBand®; (2) acustimulation (n = 40), 2 ml intravenous saline and an active ReliefBand®; and (3) combination (n = 40), 4 mg intravenous ondansetron and an active ReliefBand®. The incidences of postoperative nausea and vomiting, as well as the need for “rescue” Antiemetics, were determined at specific time intervals for up to 72 h after surgery. The outcome variables assessed included recovery times, quality of recovery score, time to resumption of normal diet, and patient satisfaction with the prophylactic Antiemetic therapy. Results Use of the ReliefBand® in combination with ondansetron significantly reduced nausea (20 vs. 50%), vomiting (0 vs. 20%), and the need for rescue Antiemetics (10 vs. 37%) compared with ondansetron alone at 24 h after surgery. Furthermore, the ability to resume a normal diet (74 vs. 35%) within 24 h after surgery was significantly improved when the ReliefBand® was used to supplement ondansetron (vs. ondansetron alone). Finally, the quality of recovery (90 ± 10 vs. 70 ± 20) and patient satisfaction (94 ± 10 vs. 75 ± 22) scores were significantly higher in the combination group versus the ondansetron group. There were no significant differences between the ReliefBand® and ondansetron when administered as adjuvants to droperidol for Antiemetic prophylaxis. Conclusions The ReliefBand® compared favorably to ondansetron (4 mg intravenously) when used for prophylaxis against postoperative nausea and vomiting. Furthermore, the acustimulation device enhanced the Antiemetic efficacy of ondansetron after plastic surgery.
Charles L Loprinzi - One of the best experts on this subject based on the ideXlab platform.
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ten year trends in Antiemetic prescribing in patients receiving highly emetogenic chemotherapy
Journal of The National Comprehensive Cancer Network, 2018Co-Authors: Ciara C Osullivan, Holly K Van Houten, Lindsey R Sangaralingham, Alexis D Leal, Shivani Shinde, Hongfang Liu, David S Ettinger, Charles L LoprinziAbstract:Purpose: Prevention of chemotherapy-induced nausea and vomiting is essential to preserve quality of life in patients with cancer receiving highly emetogenic chemotherapy (HEC). Recently, new drugs (eg, fosaprepitant, and the newer neurokinin-1 receptor antagonists [NK1RAs] rolapitant and netupitant) and updated Antiemetic guidelines have emerged. However, trends in real-world Antiemetic use are understudied. Methods: We identified patients treated with an initial dose of HEC (either cisplatin or doxorubicin/cyclophosphamide) from January 2006 to June 2016 using administrative claims data from a US commercial insurance database (OptumLabs). Antiemetic use was determined by identifying intravenous/oral/transdermal administration within ±1 day of the chemotherapy dose and/or prescription fill from 14 days before to 7 days after chemotherapy. We used descriptive statistics to present patient demographics, chemotherapy drugs administered, presence/absence of a central intravenous access device, and Antiemetics used. Results: A total of 23,030 patients (67.3%) received doxorubicin/cyclophosphamide and 11,206 (32.7%) received cisplatin. Dexamethasone and 5-hydroxytryptamine 3 receptor antagonists (5-HT3RAs) were consistently used by 85% to 95% of patients, consistent with guideline recommendations. NK1RAs were underused early on, but use increased to approximately 80% in the most recently evaluated year. Fosaprepitant use increased precipitously starting in 2009, preceding a sharp decrease in aprepitant use beginning in 2011. Receipt of olanzapine, rolapitant, and netupitant was minimal throughout the study period. Conclusions: Dexamethasone and 5-HT3RAs were used by most patients receiving HEC, in accordance with guideline recommendations. NK1RA use was less adherent with guidelines.
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Antiemetics for chemotherapy-induced nausea and vomiting occurring despite prophylactic Antiemetic therapy
Journal of palliative medicine, 2011Co-Authors: Jason M. Jones, Rui Qin, Aditya Bardia, Breanna M. Linquist, Sherry L. Wolf, Charles L LoprinziAbstract:Abstract Background: Chemotherapy-induced nausea and vomiting (CINV) is a debilitating side effect. Previous studies have primarily focused on prophylactic therapy, but no published reports have evaluated the treatment of breakthrough CINV. Methods: A prospective, pilot study was performed to provide preliminary prospective evidence of the efficacy of individual agents prescribed for the treatment of breakthrough CINV. Enrolled patients were receiving moderately or highly emetogenic chemotherapy and prophylactic treatment of CINV based on Antiemetic guidelines. Patients were prescribed an Antiemetic for breakthrough CINV at the discretion of their treating oncologist. If patients had breakthrough CINV that required a breakthrough Antiemetic medication, they were instructed to complete a questionnaire every 30 minutes for 4 hours after taking the Antiemetic. Levels of nausea (0–10), vomiting, and side effects were recorded. Results: Of the 96 patients enrolled, 27 (28%) reported breakthrough nausea and/or ...
David R Gandara - One of the best experts on this subject based on the ideXlab platform.
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control of high dose cisplatin induced emesis with an all oral three drug Antiemetic regimen
Supportive Care in Cancer, 2000Co-Authors: Paul J Hesketh, Angelie Roman, Ann M Hesketh, Edith A Perez, Martin J Edelman, David R GandaraAbstract:In this pilot trial, the Antiemetic efficacy and tolerability of an all-oral Antiemetic combination in the prevention of both acute and delayed nausea and vomiting following high-dose cisplatin was evaluated. Fifty-two patients receiving cisplatin (median dose 100 mg/m2) were entered. Patients received (1) 60 min prior to cisplatin: prochlorperazine spansule 15 mg, dexamethasone 20 mg, granisetron 2 mg; (2) 12 h after cisplatin: prochlorperazine spansule 15 mg, dexamethasone 10 mg; (3) on days 2 and 3: prochlorperazine spansule 15 mg b.i.d., dexamethasone 8 mg b.i.d.; (4) on days 4 and 5: dexamethasone 4 mg b.i.d. All Antiemetics were administered orally. The study period was the 120 h after cisplatin administration. The primary efficacy end-point was complete control (no vomiting, retching or Antiemetic rescue) of delayed emesis (24–120 h after cisplatin). Complete control of delayed emesis was achieved in 26 patients (53%). Nineteen patients (39%) noted no delayed nausea. Complete control of acute emesis (24 h after cisplatin) was attained in 44 patients (86%). The no nausea rate during the first 24 h was 74%. Overall, 39 patients (80%) were satisfied or very satisfied with their outcome. Treatment was well tolerated with infrequent and minor adverse events. In conclusion, an all-oral combination of granisetron, dexamethasone and prochlorperazine is a highly effective and well-tolerated regimen for preventing acute cisplatin-induced emesis. Control of delayed emesis was not better than with current standard treatment, and more effective approaches are needed.
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improved control of high dose cisplatin induced acute emesis with the addition of prochlorperazine to granisetron dexamethasone
The cancer journal from Scientific American, 1997Co-Authors: Paul J Hesketh, David R Gandara, Ann M Hesketh, Martin J Edelman, Lauri M Webber, Matthew Mcmanus, John D HainsworthAbstract:PURPOSE To evaluate the Antiemetic efficacy and safety of adding the dopamine antagonist prochlorperazine to the combination of granisetron and dexamethasone in the prevention of acute nausea and vomiting following high-dose cisplatin. PATIENTS AND METHODS Sixty patients receiving cisplatin (> or = 75 mg/m2) (median dose = 100 mg/m2) were enrolled at three sites. Patients received prochlorperazine spansule 15 mg orally, 60 minutes prior to and 12 hours after cisplatin; dexamethasone 20 mg intravenously, 45 minutes prior to cisplatin, and 10 mg intravenously or orally, 12 hours after cisplatin; and granisetron 10 micrograms/kg intravenously, 30 minutes prior to cisplatin. Efficacy was assessed during the 24-hour period after cisplatin using complete Antiemetic response (no emetic episodes and no rescue Antiemetics) and patient assessment of nausea and satisfaction using 100-mm visual analog scales (nausea: 0 = none, 100 = nausea as bad as it can be; satisfaction: 0 = not at all satisfied, 100 = satisfied as can be). RESULTS Complete response (0 emetic episodes) was noted in 84% (49/58) of patients. Forty-two patients (72%) experienced no nausea. The mean change in posttreatment nausea visual analog scales from baseline was 8.9 mm. Forty-eight patients (83%) were completely satisfied with their Antiemetic treatment. The mean posttreatment patient satisfaction score was 92 mm. Treatment was well tolerated, with infrequent and minor adverse events. CONCLUSIONS This three-drug Antiemetic regimen is well tolerated and highly effective in the prevention of acute nausea and vomiting arising from high-dose cisplatin. Further studies evaluating this regimen are warranted.
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Serotonin Antagonists: A New Class of Antiemetic Agents
Journal of the National Cancer Institute, 1991Co-Authors: Paul J Hesketh, David R GandaraAbstract:Despite a number of significant advances over the past decade, prevention and treatment of chemotherapy-induced emesis remain formidable problems, particularly with cisplatin-containing regimens. Nearly one third of patients receiving high-dose cisplatin still experience substantial emesis despite the best available conventional Antiemetics, and the toxic effects of these agents remain quite troublesome. In recent years, a new class of agents, the serotonin antagonists, has been identified. These agents hold promise for clinical utility in a wide range of areas. Selective antagonists of the serotonin (5-hydroxytryptamine) type 3 (5-HT3) receptor have proven in early clinical trials to be potent Antiemetic agents in patients receiving cytotoxic chemotherapy, with efficacy comparable to or superior to that of conventional Antiemetics. Toxic effects to date with the 5-HT3 receptor antagonists have been modest. The current state of knowledge with respect to these agents as Antiemetics for patients receiving cytotoxic chemotherapy is summarized.
J Herrstedt - One of the best experts on this subject based on the ideXlab platform.
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potential new agents in the prophylaxis and treatment of chemotherapy induced emesis
European Journal of Cancer, 2001Co-Authors: J HerrstedtAbstract:Results from the first two clinical trials investigating the Antiemetic effect of a serotonin3 (5-HT3)-receptor antagonist were published in 1987. The 5-HT3-receptor antagonists were the first group of drugs specially designed as Antiemetics, and today they are well-established and have revolutionised the prophylaxis of acute chemotherapy-induced nausea and vomiting. According to recently published guidelines [1,2], the combination of a 5-HT3-receptor antagonist and a corticosteroid is recommended as Antiemetic therapy during the initial 24 h after the start of treatment with moderately or highly emetogenic chemotherapy. Using such a combination, 60–90% of patients receiving cisplatin-based chemotherapy and 70–90% of those receiving moderately emetogenic chemotherapy have no emesis during the initial 24 h after chemotherapy. There are, however, a number of remaining problems in Antiemetic therapy. The 5-HT3-receptor antagonists are more successful in the prophylaxis of vomiting than in prevention of nausea from chemotherapy. Accordingly vomiting, which was the most severe chemotherapy-induced symptom before the introduction of the 5-HT3-receptor antagonists, is now ranked fifth by the patients, whereas nausea is today reported as the most severe [3]. Prophylaxis of delayed emesis (later than 24 h after chemotherapy) is less successful than prophylaxis in the acute phase, and the role of 5-HT3receptor antagonists is only modest. Therapy should be based on a corticosteroid combined with a dopamineor a 5-HT3-receptor antagonist [1,2]. Another problem is the declining efficacy of Antiemetic therapy during multiple cycles of chemotherapy [4]. The vast majority of studies have investigated Antiemetic efficacy during the initial cycle of chemotherapy only. Patients often receive four to six cycles of chemotherapy and the high protection rate against emesis obtained during the first cycle is difficult to maintain [4]. Studies addressing Antiemetic protection in patients receiving high-dose chemotherapy and bone marrow transplantation (BMT) or peripheral blood stem cell transplantation (PBSCT) are small and often heterogeneous, but results indicate that protection rates are lower compared with conventional dose chemotherapy [5]. Little is known about optimal Antiemetic therapy in patients with refractory emesis during previous cycles of chemotherapy and in patients with breakthrough emesis. Addition of a dopamine antagonist in patients with refractory emesis after treatment with cisplatin and Antiemetic therapy with a 5-HT3-receptor antagonist plus a corticosteroid seems useful [6]. Several attempts have been initiated to develop new Antiemetics such as serotonin synthesis inhibitors and drugs acting at different neuroreceptors including 5-HT1A, 5-HT2A/2C, 5-HT4 and dopamine D3, but none of these agents has so far gone into clinical trials. The most promising group of potential new Antiemetics is the substance P antagonists. The tachykinin substance P was isolated in 1931, but was not purified and sequenced before 1970. Until recently, it was thought that substance P was the only mammalian tachykinin, but now the tachykinin family also include the decapeptides neurokinin A (NKA) and neurokinin B (NKB) and the neuropeptides K (NPK) and g (NPg). The receptors for the tachykinins have been cloned and identified as G-protein coupled receptors NK1, NK2 and NK3 [7] with substance P as the preferred ligand at NK1 receptors. The potential therapeutic role of the tachykinin antagonists include emesis, depression and anxiety as the most likely areas for new drug development, but research has also been directed towards the treatment of pain, migraine and respiratory diseases. NK1 receptor antagonists require entry into the central nervous system to have Antiemetic effect. An obstacle for the clinical use of NK1 receptor antagonists as