Systematic review of antiemetic therapy for low emetogenic chemotherapy: comparing 5-HT3 receptor antagonists and dexamethasone
In brief
No head-to-head data show whether 5-HT3 blockers or dexamethasone work better for low-risk chemo nausea
A systematic review of trials from 1990-2020 found zero studies directly comparing a 5-HT3 receptor antagonist with dexamethasone alone in adults receiving low-emetic chemotherapy. Because comparative evidence is absent, guideline differences remain unsubstantiated, highlighting the need for prospective trials or real-world analyses to guide practice.
- Journal
- International journal of clinical oncology (Q1)
- Published
- 21 July 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Takeshi Aoyama, Hirotoshi Iihara, Masakazu Abe, Makoto Wada, Keiko Iino, Tatsuo Akechi, et al.
- PMID
- 42479257
- DOI
- 10.1007/s10147-026-03120-0
Why clinicians should know about it
- Picked for Hematology (top studies of the week, 26 July 2026): SR of antiemetic therapy for low‑emetic chemo
Abstract
BACKGROUND: Chemotherapy-induced nausea and vomiting (CINV) significantly impact quality of life of patients with cancer. Although antiemetic guidelines exist for low-emetic chemotherapy (LEC), recommendations vary across international guidelines and direct evidence comparing 5-HT3 receptor antagonists (5-HT3 RAs) with dexamethasone monotherapy is lacking. METHODS: We conducted a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for randomized controlled trials, nonrandomized comparative studies, and observational studies directly comparing 5-HT3 RA with dexamethasone monotherapy in adult patients with LE, using PubMed, the Cochrane Library, CINAHL, and Ichushi-Web from January 1990 to December 2020. RESULTS: A systematic search identified 427 articles (87 from PubMed, 337 from the Cochrane Library, and three from Ichushi-Web), with three additional records identified through other sources. After the first screening of 430 articles, 425 records were excluded, and five records were used for full-text assessment. Following the second screening, five full-text articles were excluded for not meeting the inclusion criteria. CONCLUSIONS: This systematic review identified no direct comparative evidence. Future efforts to strengthen the evidence base should include not only prospective comparative trials where feasible but also observational studies, real-world data analyses, and other complementary approaches that better reflect routine clinical practice.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.