Antiemetics: American Society of Clinical Oncology Clinical Practice Guideline Update

Abstract

Purpose To update the ASCO guideline for antiemetics in oncology. Methods ASCO convened an Expert Panel and conducted a systematic review of the medical literature for the period of November 2009 to June 2016. Results Forty-one publications were included in this systematic review. A phase III randomized controlled trial demonstrated that adding olanzapine to antiemetic prophylaxis reduces the likelihood of nausea among adult patients who are treated with high emetic risk antineoplastic agents. Randomized controlled trials also support an expanded role for neurokinin 1 receptor antagonists in patients who are treated with chemotherapy. Recommendation Key updates include the addition of olanzapine to antiemetic regimens for adults who receive high-emetic-risk antineoplastic agents or who experience breakthrough nausea and vomiting; a recommendation to administer dexamethasone on day 1 only for adults who receive anthracycline and cyclophosphamide chemotherapy; and the addition of a neurokinin 1 receptor antagonist for adults who receive carboplatin area under the curve ≥ 4 mg/mL per minute or high-dose chemotherapy, and for pediatric patients who receive high-emetic-risk antineoplastic agents. For radiation-induced nausea and vomiting, adjustments were made to anatomic regions, risk levels, and antiemetic administration schedules. Rescue therapy alone is now recommended for low-emetic-risk radiation therapy. The Expert Panel reiterated the importance of using the most effective antiemetic regimens that are appropriate for antineoplastic agents or radiotherapy being administered. Such regimens should be used with initial treatment, rather than first assessing the patient’s emetic response with less-effective treatment. Additional information is available at www.asco.org/supportive-care-guidelines and www.asco.org/guidelineswiki .

Hydration Requirements with Emetogenic Chemotherapy: Granisetron Extended-Release Subcutaneous Versus Palonosetron

“…Granisetron and palonosetron are two of several 5-HT 3 receptor antagonist antiemetics included in antiemetic guidelines [11][12][13][14]. A recent addition to this class is granisetron extended-release subcutaneous (GERSC; Sustol R ), a novel formulation of 2% granisetron in a viscous bioerodible Biochronomer R tri(ethylene glycol) poly(orthoester) (TEG-POE) polymer [15].…”

“…Clinical practice guidelines recommend a combination of antiemetics of different classes for the prevention of CINV, including 5-hydroxytryptamine type 3 (5-HT 3 ) receptor antagonists, neurokinin 1 (NK-1) receptor antagonists and dexamethasone [11][12][13][14]. Granisetron and palonosetron are two of several 5-HT 3 receptor antagonist antiemetics included in antiemetic guidelines [11][12][13][14].…”

“…Despite comprehensive antiemetic treatment guidelines [11][12][13][14], there is still an unmet clinical need to improve the prevention of CINV.…”

Pharmacokinetics/pharmacodynamics, safety, and tolerability of fosaprepitant for the prevention of chemotherapy‐induced nausea and vomiting in pediatric cancer patients

“…There are several guidelines for the prevention of CINV associated with highly emetogenic chemotherapy (HEC) and moderately emetogenic chemotherapy (MEC) . Mainstays of treatment include an oral neurokinin‐1 receptor antagonist (NK 1 RA), a serotonin receptor (5‐HT 3 ) antagonist, and dexamethasone.…”

“…For pediatric patients receiving HEC, most guidelines recommend a three‐drug combination of a 5‐HT 3 antagonist, dexamethasone, and the oral NK 1 RA, aprepitant. Two‐drug combinations of a 5‐HT 3 antagonist and dexamethasone can be used if aprepitant is contraindicated, or aprepitant with a 5‐HT 3 antagonist if dexamethasone is contraindicated . For pediatric patients scheduled to receive MEC, guidelines recommend a two‐drug combination of 5‐HT 3 antagonist and dexamethasone or, if dexamethasone is contraindicated, 5‐HT 3 antagonist with aprepitant …”