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Dexrazoxane Prevention of Anthracycline Cardiomyopathy

2013; Lippincott Williams & Wilkins; Volume: 31; Issue: 10 Linguagem: Inglês

10.1200/jco.2012.46.9908

1527-7755

Rudolf Steiner, K. Hellmann,

Chemotherapy-related skin toxicity

dexamethasone (61% v 52%) on days 2 and 3.Although true, we are not sure of its relevance when the more detailed measure of average nausea, which was our primary outcome, and peak nausea were each significantly improved by the addition of dexamethasone on days 2 and 3. Rather than using a simple dichotomous measure of yes or no to assess nausea rates, we used average nausea on the basis of 11 assessment points, each on a 7-point scale.The peak nausea variable in our analyses was the highest nausea reported at any of these 11 reporting points.Celio and Aapro 2 raise an important point regarding aprepitant for control of vomiting.In our discussion of vomiting in the online-only Appendix, 1 we noted that although aprepitant was not more effective than prochlorperazine in controlling DN when both were combined with palonosetron and dexamethasone, this lack of a statistically significant difference could be moderated with what might be a clinically relevant benefit for patients receiving aprepitant.That is, patients receiving aprepitant had a nearly statistically significant lower incidence of DV than patients receiving prochlorperazine (8% v 14%), and also had significantly less DN if DV did occur.Concerning the assessment of Celio and Aapro that our "data indicate that prochlorperazine may play a specific role in DN when acute emesis is well controlled," we concur, provided that the word "delayed" is substituted for the word "acute."However, we think a better way to conceptualize our findings is to say that aprepitant may be more helpful than prochlorperazine in approximately 14% of patients, either by providing more effective control of DV or by helping to control nausea when DV does occur.Given that we found no benefit of palonosetron compared with granisetron in any of our analyses and, for 86% of patients, there was no benefit of aprepitant compared with prochlorperazine, we suggest that the widespread use of palonosetron be reconsidered, and a more targeted approach be used for aprepitant.We are also pleased with the positive comments on our article by Ishiguro et al. 4 They raise important issues not addressed in our article 1 concerning the substantially greater costs of the newer antiemetics compared with the older generic ones, and concerning the financial support and design of large antiemetic trials.Their points are well taken.