Abstract
BACKGROUND: Temozolomide, the most important chemotherapeutic agent used in neurooncology, has moderate emetogenic potential. With the introduction of ondansetron, the first 5HT3-antagonist on the market, most of us neurooncologists thought that the problem of nausea and emesis was resolved. Some patients, however, report on severe nausea and vomiting during treatment. We therefore initiated a study on nausea and quality of life during chemotherapy of neurooncological diseases. METHODS: The MASCC questionnaire on nausea and emesis includes an 11-step scale on nausea and frequency of vomiting. We midified it with a visual analogue scale and ask patients to fill this in one day before and 10 days from the start of chemotherapy for 2 cycles. Additional questions aks for anticipatory vomiting. In order to assess a possible influence of depressive symptoms and the impact of chemotherapy on quality of life, EORTC QLQ-C30 with BN20 and health questionnaire 9 are asked to be filled in once before and for two cycles during chemotherapy. RESULTS: At abstract submission, 17 patients treated with temozolomide were included. The absolute doses of temozolomide ranged from 60 to 420mg, according to the respective dosing regimen. Antiemetic treatment included aliprazide 50mg, ondansetrone 8mg, granisetrone 2mg or palonosetrone 0.5mg. Two thirds of patients (12/17) did not suffer from nausea and emesis. Relevant nausea only occurred at doses of 200mg or more of temozolomide. With aliprazide, the maximal intensity of nausea of 10 at the visual analogue scale was already reached with 200mg of temozolomide day 1. By contrast, maximal values of only 7 occurred with ondansetrone and granisetrone with a delayed peak at day 3. With palonosetrone, max. values of 4 were reached at day 3 even with 420mg of temozolomide. Of note, nausea often persisted for 2-3 days after application of temozolomide. CONCLUSIONS: To our knowledge, this is the first study to assess nausea and emesis over a longer period of time. The preliminary analysis already shows marked differences between patients, depending from the dose of temozolomide and the antiemetic regimen. The intensity can be maximal and the duration longer than the application of chemotherapy. This demonstrates that nausea and emesis can be more intense than generally noted and should carefully be asked for and treated with long lasting antiemetics. Updated results of this ongoing study with more patients included and more detailed subgroup analysis will be presented.