ADIS PROFILE SUMMARY
Drugs R&D 1999 Oct; 2 (4): 237-239 1174-5886/99/0010-0237/$01.50/0 © Adis International Limited. All rights reserved.
Antiemetics for Cancer Chemotherapy–Induced Nausea and Vomiting Summary and Table Katharine J. Palmer and Raewyn Poole Adis International Limited, Auckland, New Zealand
Adis Comment
All drugs appearing in the Adis Profile Summary table have been selected based on information contained in R&D Insight™ , a proprietary product of Adis International. As the emphasis of Drugs in R&D is on the clinical potential of new drugs, selection of agents for full profile is based on the extensiveness of available data. Information on all drugs in clinical development, as identified from R&D Insight™ , is included in the summary table. Information and/or profiles of agents in preclinical development may be included as appropriate.
Although undoubtedly effective in many patients, cancer chemotherapy is often associated with nausea and vomiting. A significant proportion of patients develop nausea and emesis following chemotherapy, despite the widespread use of antiemetic agents.[1] Chemotherapy-induced nausea and vomiting (CINV) can take several forms: acute, delayed or anticipatory. Acute CINV is defined as that occurring within 24 hours of the start of chemotherapy; delayed CINV as that which occurs 24 hours or more after the start of chemotherapy; and anticipatory vomiting as that which occurs before the initiation of chemotherapy in response to oncology-related stimuli. CINV is associated with physiological complications, such as fatigue, muscle strain, oesophageal tears, electrolyte disturbances and dehydration, and can cause marked distress in affected patients. Indeed, in a study of quality of life in 433 patients with cancer before and after administration of moderately and highly emetogenic chemotherapy, the parameter was found to be significantly lower in
those patients who experienced chemotherapyinduced vomiting.[2] Nausea and vomiting are also associated with considerable costs. Direct costs include the nursing and medical staff costs of dealing with vomiting, materials used (e.g. changes of linen and clothing), and additional patient time spent in hospital due to inadequate control of vomiting. Indirect costs include lost or reduced patient and/or caregiver productivity resulting from time diverted from paid or unpaid employment to manage the consequences of nausea and vomiting.[3,4] At present, the ‘gold standards’for CINV are the serotonin 5-HT3 receptor antagonists, such as granisetron and ondansetron. However, as pointed out by Drs Rizk and Hesketh, these agents are not particularly effective against delayed CINV. This leaves a need for further agents to deal with this debilitating condition. The Profile Table outlines the agents identified from Adis International’s R&D Insight database that are in clinical development for the treatment
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of CINV. Full profiles are provided for those agents that are in at least phase II development. A number of companies continue to target 5HT3 receptors, with agents such as itasetron and palonosetron in phase III development. The most exciting avenue of research, however, is that which is assessing the effects of agents that act on the neurokinin system. Neurokinin NK1 receptor antagonists, such as CP 122721, CJ 11974 and MK 869, appear to be clinically effective against both acute and delayed CINV induced by cisplatin. Greater control of CINV from the first exposure to the treatment should reduce the incidence of anticipatory nausea and vomiting, and make treatment
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Adis Profile Summary
more acceptable to patients. A reduction in the costs associated with the condition can also be anticipated. References 1. Roscoe JA, Morrow GR, Bennett JM, et al. Updates from a 7-year monitoring study of chemotherapy induced anticipatory and posttreatment nausea and vomiting. University of Rochester Cancer Center Second Annual Science Symposium; 1997: 50 2. Osoba D, Zee B, Warr D, et al. Quality of life studies in chemotherapy-induced emesis. Oncology 1996; 53 Suppl. 1: 92-5 3. Goddard M. The real costs of emesis. Eur J Cancer 1993; 29A (3): 287-8 4. O’Brien BJ, Rusthoven J, Rocchi A, et al. Impact of chemotherapy-associated nausea and vomiting on patients’ functional status and on costs: survey of five Canadian centres. Can Med Assoc J 1993; 149: 296-302
Drugs R&D 1999 Oct; 2 (4)
Drug (synonyms/brand names)
Originator [other WHO therapeutic class companies]
Mechanism of action PK characteristics [route of elimination]
Route
Adverse events
PD
Country of highest phase
Registered Ravizza [Alter]
A04A-D (Other antiemetics), Dopamine D2 N05A-L (Benzamides), receptor antagonists N06A-X (Other antidepressants)
Antiemetic, antiItaly Occasional: blurred depressant and vision, confusion, antipsychotic activity constipation, neurological manifestations
CJ 11974
Pfizer
A04A-D (Other antiemetics), Neurokinin-1 N02B (Other Analgesics and antagonist, Antipyretics) substance P antagonist
Occasional: azotaemia, dehydration
Itasetron (DAU 6215, U 98079)
Boehringer Ingelheim [Pharmacia & Upjohn]
A04A-A (Serotonin 5-HT3 Serotonin 5-HT3 antagonists), N05A-X (Other antagonists antipsychotics), N05B-X (Other anxiolytics), N07X (Other Nervous System Drugs)
Levosulpiride (Levopraid, RV 12309)
Adis Profile Summary
© Adis International Limited. All rights reserved.
Adis Profile Table for Agents in Development for Cancer Chemotherapy–Induced Emesis. Drugs are cited in their highest phase of development for the indication then in alphabetical order
Phase III
Palonosetron Roche (RS 25259, RS 25259 197) Bioscience
Linear kinetics; t1 ⁄2 β 12.4h; F 68%
USA
PO
Occasional: abdominal pain, anorexia, constipation, fatigue, headache, xerostomia
Germany, Antiemetic, Japan, USA anxiolytic and cognition enhancing activity
Most frequent: headache
Antiemetic activity
A04A-A (Serotonin 5-HT3 antagonists)
Serotonin 5-HT3 antagonists
PO
Serotonin 5-HT3 antagonists
IV; PO
USA
Phase II Lerisetron (F 0930, F 0930RS)
FAES
A04A-A (Serotoin 5-HT3 antagonists)
MK 869 (L 754030, MK 0869)
Merck & Co
A04A-D (Other antiemetics), Neurokinin-1 N06A-X (Other antagonists, antidepressants) substance P antagonists
Zatosetron (LY 191617, LY 277359)
Eli Lilly
A04A-A (Serotonin 5-HT3 Serotonin 5-HT3 antagonists), N05B-X (Other antagonists anxiolytics)
Eli Lilly [Cerebrus]
A04A-D (Other antiemetics) Serotonin 5-HT1A receptor agonists
CI 1021 (PD 154075)
Parke-Davis
A04A (Antiemetics and Antinauseants)
CP 122721
Pfizer
A04A-D (Other antiemetics), Neurokinin-1 N02B (Other Analgesics and antagonists Antipyretics)
PO
L 758298
Merck & Co
A04A-D (Other antiemetics) Neurokinin-1 antagonists
IV
Active metabolites; tmax 6.00h; t1 ⁄2 β 30.00h [renal]
Antiemetic activity in Spain animal studies USA
PO
Occasional: asthenia, fatigue, headache, nausea, somnolence
Inhibits acute and delayed cisplatininduced emesis in ferrets
IV; PO
Most frequent: constipation, somnolence. Occasional: anxiety, depression, headache
USA Antiemetic and anxiolytic activity; gastroprokinetic activity at low doses
Phase I CEB 1555
UK
Clinical phase unknown Neurokinin-1 antagonists
Unknown
USA
Occasional: diarrhoea, elevated aminotransferase levels, headache
Inhibits acute cisplatin-induced vomiting in ferrets
USA
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Drugs R&D 1999 Oct; 2 (4)
Reduction of the acute and delayed emetic response to cisplatin
