Sponsored: Anti-emetics are standard of care in preventing chemotherapy related vomiting
The use of chemotherapeutic agents for cancer treatment has long been a common approach in treating veterinary patients. Access to more sophisticated diagnostics and treatments have increased over time, and more pet owners are willing to seek advanced care for their beloved pets when diagnosed with cancer.
Clinicians now have a broader range of options to offer from conventional chemotherapy to radiation therapy to targeted approaches such as the use of tyrosine kinase inhibitors. Despite the benefits of chemotherapeutic agents in the treatment of cancer, there are often unwanted side effects that must be managed throughout the course of therapy.
The 2016 AAHA Oncology Guidelines for Dogs and Cats emphasizes the awareness of chemotherapy side effects and the importance of managing them.[1]
The most common problem related to chemotherapy that owners identify at home is gastrointestinal toxicity. Vomiting can occur acutely, but is most often delayed and not apparent for 24-48 hours after administration of chemotherapy.[2]
Some drugs such as cisplatin may induce vomiting within as little as six hours of administration. In one study of canine cancer patients receiving cisplatin at Purdue University, 27 of 41 dogs (66%) vomited.[3] This demonstrates the frequency in which patients may experience undesirable side effects like vomiting during treatment—a very unpleasant experience for the patient as well as the pet owner.
A commonly used medication, maropitant citrate, is the first and only FDA approved medication for the prevention of vomiting in dogs caused by chemotherapeutic medications. Studies have demonstrated the efficacy of maropitant citrate in preventing chemotherapy related vomiting, specifically reducing the frequency and intensity of vomiting when agents such as cisplatin and doxorubicin were administered.[4], [5]
A second publication from Colorado State University evaluated the efficacy of maropitant citrate to prevent chemotherapy related vomiting, specifically reducing the frequency of vomiting when cisplatin was administered.5 In this randomized, double-blind, placebo-controlled study, 122 dogs were randomly assigned to three groups to receive treatments as following:
- T01: placebo before and after cisplatin infusion
- T02: placebo before and 1 mg/kg maropitant citrate SC after cisplatin infusion
- T03: 1 mg/kg maropitant citrate SC before and placebo after cisplatin infusion
For dogs administered maropitant citrate prior to cisplatin treatment as a preventive measure (T03), 94.9% did not vomit and significantly fewer emetic events (p<0.0001) were observed in those dogs that did vomit.
Injectable maropitant citrate is approved for use in preventing vomiting caused by chemotherapeutic agents in dogs 4 months of age and older. It should be used with caution in dogs with known hepatic dysfunction because it is metabolized by CYP3A and CYP2D15 enzymes.
For more information on the prevention of vomiting and other resources related to the use of maropitant citrate in practice, please follow this link.
About the Author:
Daniel K. Edge, DVM, MBA is a Veterinary Medical Lead for Zoetis US Companion Animal Division with focus on Pain, Oncology, and Specialty products.
This content was provided by Zoetis.
1) Biller B, Berg J, Garrett L, Ruslander D, Wearing R, Abbott B, Patel M, Smith D, Bryan C.”2016 AAHA Oncology Guidelines for Dogs and Cats”. JAAHA 2016 Jul-Aug; 52(4): 181-204.
2) Lana SE, Dobson, JM. (2011). Principles of Chemotherapy. In Dobson JM, Lascelles BDX (Eds.), BSAVA Manual of Canine and Feline Oncology (61-79). Gloucester: BSAVA.
3) Knapp DW, Richardson RC, Bonney PL et al. Cisplatin therapy in 41 dogs with malignant tumors. J Vet Intern Med 1988 2, 41-46.
4) Rau SE, Barger LG, Burgess KE. Efficacy of maropitant in the prevention of delayed vomiting associated with administration of doxorubicin to dogs. J Vet Intern Med 2010;24(6):1452–7.
5) Vail DM, Rodabaugh HS, Conder GA, Boucher JF, Mathur S. Efficacy of injectable maropitant (Cerenia) in a randomized clinical trial for prevention and treatment of cisplatin-induced emesis in dogs presented as veterinary patients. Vet Comp Oncol 2007 Mar; 5(1): 38-46.
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