chemotherapeutic agent in the curative treatment of advanced testicular cancer and is
effective in a number of other carcinomas including those arising in lung, ovary, head and
neck, and urinary bladder, and APUD tumors. The major toxicities of cisplatin are renal
tubular injury, electrolyte disturbances nausea, vomiting, anemia, ototoxity, and peripheral
neuropathy. Severe nausea and intolerable vomiting are universal without propylaxis with
antiemetics and begin within 1 to 4 hours and last over 24 hours. This debilitating side
effect is the major cause of cessation of effective cancer chemotherapy in some patients.
Nausea and vomiting, therefore, can be potentially fatal toxicities in those patients with
curable diseases who refuse therapy.
In a survey, 67% of physicians queried 1% to 5% of their patients and another 15% of the
physicians reported 5% to 10% of their patients refused treatment because of nausea and
vomiting. Uncontrolled bouts of retching and vomiting after chemotherapy have induced
Mallory-Weiss eosphagogastric tears, pathologic fractures, dehydration with metabolic
imbalance, anorexia, and weight loss.
In contrast to the recognition of the many potential consequences, the mechanisms for
chemotherapy-induced nausea and vomiting are not known. The deeplying medullary
emetic center coordinates the act of vomiting but is not itself sensitive to chemical stimuli. It
appears that chemotherapeutic agents induce vomiting directly or indirectly at various
trigger sites in the body, such as the chemoreceptor trigger zone (CTZ) in the mid-brain
and other unidentified centers in cerebral cortex and gastrointestinal tract. Data on major
sources of emetic input are currently obtained from animal studies. The mechanism of
cisplatin induced emesis is unclear. Cisplatin, which has poor penetration of the blood-brain
barrier, may induce primarily through peripheral pathways. Stimulation of the CTZ may also
play a role. The role of higher cortical centers is apparent in anticipatory nausea and
vomiting preceding repeated doses of chemotherapy.
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