Efficacy and Tolerability of Granisetron Versus Ondansetron in the Prevention of Chemotherapy Induced Nausea and Vomiting Among Cancer Patients at Kenyatta National Hospital

Abstract

ABSTRACT Background Nausea and vomiting experienced by patients receiving cytotoxic therapy is distressing and occasionally debilitating. Differences and similarities in the effectiveness among serotonin-receptor antagonists have been reported in clinical studies and this has prompted the current study to determine whether the differences are considerable in terms of clinical efficacy and tolerability at Kenyatta National Hospital. Objective To compare the antiemetic effect of granisetron and ondansetron each combined with dexamethasone among patients receiving cisplatin based chemotherapy regimens at Kenyatta National Hospital. Methodology Thirty-four adult cancer patients scheduled to receive two consecutive three weekly cycles of cisplatin based chemotherapy regimens for the first time (at doses > 50 mg/m2), were recruited into a double-blind randomized crossover study to receive ondansetron 12mg or granisetron 3mg each combined with dexamethasone 8mg as intravenous on the first day. On days 2 to 4 post chemotherapy participants received oral treatment, either ondansetron or granisetron each combined with dexamethasone as prophylaxis against delayed emesis. The frequency of nausea and vomiting were assessed daily until 5th day post chemotherapy. Data were collected using a close ended questionnaire and reported as frequencies (%). Statistical analysis was done using STATA software version 13. Statistical significance was done using Fisher’s exact test for each variable and it was termed significant when p value was less than 0.05. Results There was a female predominance at 70.6%. The predominant age category was 50-70 years at 47.1% and mean age was 53.5 (±11.9) years. The commonest type of cancer was cervical followed by head and neck cancer. There was no statistically significant difference between ondansetron and granisetron associated with patient’s xvii sociodemographic characteristics, but on the dosage of cisplatin variable at first day of the delayed phase (p values < 5%). Incidences of acute and delayed nausea and vomiting were more frequent in first compared to second cycle where most patients vomited once in five days. The peak incidence was observed on day two post chemotherapy and antiemetic administration. Complete prevention of acute and delayed vomiting/nausea was observed in about 80% of patients receiving either of the treatments. Adverse effects were not significantly different between the two antiemetic regimens, although the most frequent were malaise/fatigue and headache. Direct cost with granisetron based antiemetic treatment regimen was higher compared with the one with ondansetron at a ratio of approximately 10:1. Conclusion Ondansetron and granisetron each combined with dexamethasone have similar efficacy and tolerability in the prevention of cisplatin-induced emesis. The choice to use any of them should depend on direct cost. Recommendations Ondansetron should be preferred to granisetron in view of its lower cost and further research for complete prevention of delayed chemotherapy induced nausea and vomiting requires to be done.