Original: March 2000
The MEDLINE and CANCERLIT databases were originally searched from January 1987 to November 1997. This search was updated in November 1998, April 1999 and October 1999. The search terms included the medical subject headings (MeSH) ondansetron, granisetron, neoplasms, practice guidelines, meta-analysis, randomized controlled trials, double-blind and single-blind method; and the text words ondansetron, granisetron, dolasetron, tropisetron, 5HT3 antagonist(s), serotonin antagonist(s), randomized controlled trial and random (truncated). The search also included the publication types practice guideline, meta-analysis and randomized controlled trial. The Physician Data Query (PDQ), the Cochrane Library and the proceedings of the annual meeting of the American Society of Clinical Oncology (ASCO) (1995-1999) were also searched for reports of new or ongoing trials. The lead author checked his personal files for reports of relevant studies. Articles and abstracts were selected and reviewed, and the reference lists from these sources were searched for additional trials.
Update: January 2003
The original literature search has been updated using MEDLINE (through January 2003), CANCERLIT (through October 2002), the Cochrane Library (Issue 4, 2002), the Physician Data Query database, the Canadian Medical Association Infobase, the National Guideline Clearinghouse, and abstracts published in annual meeting proceedings of the American Society of Clinical Oncology (through 2002). Article bibliographies and personal files were also searched to January 2003 for evidence relevant to this practice guideline report.
Inclusion Criteria
Articles were selected for inclusion if they met the following criteria:
- Reports of randomized trials comparing one or more 5-HT3 receptor antagonists (dolasetron, granisetron, ondansetron or tropisetron) with a suitable control group (placebo or antiemetic) in adult cancer patients receiving moderately or highly emetogenic chemotherapy.
- Since emesis and nausea are subjective endpoints, only the results of randomized double-blind studies were used to formulate the recommendations of this guideline.
- It has been demonstrated that antiemetics used prior to chemotherapy influence the frequency of delayed-onset emesis. Therefore, to address the question of duration of administration of 5-HT3 receptor antagonists, this overview includes only those studies in which the same antiemetics were administered in both the treatment group and the control group during the first 24 hours, or those in which randomization occurred 24 hours after the initial antiemetic therapy.
Exclusion Criteria
- Phase I and II studies were not considered for inclusion in this report because of the availability of randomized controlled trials.
- Letters and editorials were not considered.
- Papers published in a language other than English were not considered.
- Studies where different 5-HT3 antagonists were used during the first 24 hours were ineligible.