Gender and anthropometrics of patients undergoing cisplatin-containing chemotherapy as determinants of acute emesis over repeat courses

Abstract

Objective. To characterize the anthropometric and pharmacotherapeutic variables related to acute emesis over repeat courses of cisplatin-containing regimens (≥50 mg/m survival analysis.2) by means of survival analysis. Methods. A prospective, cross-sectional non-controlled study was started to analyse acute vomiting in patients treated in a general hospital. The patients received an intravenous combination of drugs based on metoclopramide (two 3 mg/kg doses), diphenhydramine (20 mg) and dexamethasone (20 mg) as first choice antiemetic treatment. An intravenous regimen based on ondansetron (8 mg) and dexamethasone (20 mg) was given as an alternative regimen. Therapeutic failure was defined as the recording of one or more vomiting episodes on a self-evaluation sheet. Other variables included were chemotherapeutic regimen, antiemetic regimen, gender, age, weight and height. The statistical analysis was developed using the Cox proportional hazards model. Results. Eighty-eight patients were finally included in the study, 16 women (18%) and 72 men (82%). The metoclopramide-based regimen was administered to 74 patients (84%) and the ondansetron-based regimen to 14 patients (15%). The univariate analysis showed that any variable included in the study was significant. The multivariate survival analysis retained three variables: height (hazard ratio 1.22), gender (hazard ratio 2.12) and weight (hazard ratio 1.44) of the patients. It is hypothesized that gender and anthropometrics of patients could represent differences in pharmacokinetic and/or pharmacodynamic behaviour of cisplatin and/or antiemetics. The potential role of these parameters in these drugs is discussed. Conclusions. Emesis over repeat courses in cisplatin-containing regimens seems a function of the gender and anthropometrics of patients, irrespective of the antiemetic regimen and the emetogenicity of the cytostatics. Dosing individualization of cisplatin and/or antiemetics based on pharmacokinetic and/or pharmacodynamic parameters can be a valid tool to increase the effectiveness and safety of these drugs.