Antiemetic Use in Oncology: Updated Guideline Recommendations from ASCO

Abstract

Overview: In 2011, ASCO updated its guideline for the use of antiemetics in oncology, informed by a systematic review of the medical literature. This is an abbreviated version of that guideline, which is available in full at www.asco.org/guidelines/antiemetics . Key changes from the prior update in 2006 include the following: Combined anthracycline and cyclophosphamide regimens were reclassified as highly emetic. Patients who receive this combination or any highly emetic agents should receive a 5-HT3 receptor antagonist, dexamethasone, and an NK1 receptor antagonist. A large trial validated the equivalency of fosaprepitant, a single-day intravenous formulation, with aprepitant; either therapy is appropriate. Preferential use of palonosetron is recommended for moderate emetic risk regimens, combined with dexamethasone. For low-risk agents, patients can be offered dexamethasone before the first dose of chemotherapy. Patients undergoing high emetic risk radiation therapy should receive a 5-HT3 receptor antagonist before each fraction and for 24 hours following treatment and may receive a 5-day course of dexamethasone during fractions 1 to 5. Continued symptom monitoring throughout therapy is recommended. Clinicians often underestimate the incidence of nausea, which is not as well controlled as vomiting. Detailed information about the development of the guideline as well as practice tools are available at www.asco.org/guidelines/antiemetics .

Herbal medicines for the treatment of cancer chemotherapy-induced side effects

“…Nausea and vomiting are caused by activation of vagal afferent neurons through the release of 5-HT and substance P from the enterochromaffin cells in the gut via 5-HT3 and neurokinin (NK)-1 receptors, respectively. Antagonists of 5-HT3 and NK-1 receptors have been developed and are widely used for the treatment of chemotherapy-induced nausea and vomiting ( Roila et al, 2010 ; Basch et al, 2012 ). On the other hand, anorexia has been reported to be associated with other 5-HT receptors; 5-HT2R or 5-HT3R antagonists are associated with a decrease in food intake, leading to anorexia, as concluded from animal experiments ( De Vry and Schreiber, 2000 ; Hayashi et al, 2005 ).…”

“…International guidelines for antiemetic use have recommended antagonists for 5-HT3 and NK-1 receptors as well as corticosteroids for patients undergoing treatment with anticancer drugs including cisplatin ( Roila et al, 2010 ; Basch et al, 2012 ). However, the effect of this treatment is still insufficient, because the complete response rate and complete control rate have been reported to be 40–75%, and anorexia as an adverse event was reported in approximately 15% of patients ( Hesketh et al, 2003 ; Poli-Bigelli et al, 2003 ; Schmoll et al, 2006 ).…”

Efficacy and safety of fosaprepitant in the prevention of nausea and vomiting following highly emetogenic chemotherapy in Chinese people: A randomized, double-blind, phase III study

“…Both fosaprepitant and aprepitant are potent and selective NK1R antagonists that can improve prevention of CINV in patients receiving moderately emetogenic chemotherapy (MEC) and HEC with the addition to a standard regimen of a 5-HT 3 RA and dexamethasone (Langford & Chrisp, 2010;Ruhlmann & Herrstedt, 2012). Current guidelines recommend this three-drug combination in the control of CINV in patients receiving HEC (Basch et al, 2012;Jordan, Gralla, Jahn, & Molassiotis, 2014). Fosaprepitant is a water-soluble, phosphorylated analog of aprepitant.…”

The Effects of Acupressure on Meridian Energy as well as Nausea and Vomiting in Lung Cancer Patients Receiving Chemotherapy

“…A combination regimen of any type of chemotherapeutic agent plus platinum-containing chemotherapeutic agents has been found to improve outcomes, achieving a response rate of 25–35% and a 1-year survival rate of 30–40%. However, over 90% of all cancer patients receiving chemotherapy without antiemetic prophylaxis experience side effects of nausea and vomiting (Basch et al, 2012; Ettinger et al, 2012). These symptoms not only increase length of hospital stay and economic burden on health-care services but also have a significant negative impact on patients’ quality of life and energy consumption, thereby reducing patients’ willingness to continue to receive treatment (Chuang, Lian, & Fang, 2014; Farrell, Brearley, Pilling, & Molassiotis, 2013).…”