Chemo s dreaded side effects, and how miraculous drugs changed the entire landscape

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Of all the enormous medical advances during the past 10-20 years, one drug in particular (ondansetron, Zofran) which completely revolutionized the management of chemotherapy induced nausea and vomiting (CINV) usually flies under the radar.

Screen Shot 2014-10-14 at 1.51.25 PMOf all the enormous medical advances during the past 10-20 years, one drug in particular (ondansetron, Zofran) which completely revolutionized the management of chemotherapy induced nausea and vomiting (CINV) usually flies under the radar.

Yet, the drug, which was designed by GlaxoSmithKline, has had an enormous effect in controlling CINV since its approval in 1987. So much so that even the most emetogenic (causing vomiting) drugs, such as cisplatin which had close to a 100 percent rate of managing CINV have been tamed. But not entirely.

Since its approval, Zofran has also been approved for postoperative nausea and vomiting, as well as for morning sickness and viral gastrointestinal infections. This reduces the need for hospital admission as a result of dehydration and electrolyte imbalance, which can be caused by protracted vomiting.

For example, Dr. John Dunn, M.D., a consultant in emergency services at the Carl R. Darnall Army Medical Center in Fort Hood, Texas, has said We see hundreds of kids every month at our emergency department. The nurses have the authority to administer Zofran one of the safest drugs we have for vomiting kids as young as 2 months right at the door. By the time I see the kids, they are already feeling fine and sucking on a Popsicle.

There is one area in which Zofran fails. CINV has two components: an acute phase following administration of the chemo drug, and a delayed phase, which can start 24 hours post-chemo and last up to one week. Zofran works very well for the first, but not for the second. (Note: palonosetron (Aloxi) which was approved in 2003 is a more potent chemical cousin of Zofran and does work for the delayed phase in about 80 percent of patients.)

It just got better. The FDA has just approved a two drug combination called Akynzeo a combination of palonosetron plus netupitant, which works by a different mechanism.

The results are impressive. Akynzeo prevented 98.5 percent of CINV in the acute phase (vs, 89.7 percent of patients who got only palonosetron), and more than 90 percent in the delayed phase. something that would have been unimaginable two decades ago.

ACSH s Dr. Josh Bloom says, The most unpleasant and most feared side effect of chemo is the unrelenting nausea and vomiting. This can be so severe that many patients simply stop treatment before the course is over. This advance is important not only because it relieves awful symptoms, but because it will certainly save lives. Now people who could otherwise not tolerate the chemo will be able to finish the entire course of treatment.