Classification of the acute emetogenicity of chemotherapy in pediatric patients: A clinical practice guideline

Sing, Edric Paw Cho; Robinson, Paula D.; Flank, Jacqueline; Holdsworth, Mark T.; Thackray, Jennifer; Freedman, Jason L.; Gibson, Paul; Orsey, Andrea; Patel, Priya; Phillips, Bob; Portwine, Carol; Raybin, Jennifer; Cabral, Sandra; Sung, Lillian; Dupuis, L. Lee

doi:10.1002/pbc.27646

Cited by 48 publications

(46 citation statements)

References 17 publications

(31 reference statements)

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“…Chemotherapy-induced nausea and vomiting (CINV) can negatively impact a child's ability to maintain a nutritious diet and should be addressed as a priority in treating children ( 89 ). Algorithms can be developed to prioritize interventions based on the emetogenic potential of chemotherapy ( 90 ). Although medications often used in HIC cancer centers to address CINV may be cost prohibitive in LMICs, more economical alternatives can be considered while also advocating for the inclusion of antiemetics in essential medicine lists for children with cancer in LMICs ( 91 , 92 ).…”

Section: Current Status Of Knowledgementioning

confidence: 99%

Perspective: Creating the Evidence Base for Nutritional Support in Childhood Cancer in Low- and Middle-Income Countries: Priorities for Body Composition Research

Murphy‐Alford

Prasad

Slone

et al. 2020

Advances in Nutrition

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There is a striking disparity in survival rates for children in low- and middle-income countries (LMICs) compared with high-income countries (HICs). Many of the contributing factors are preventable, including the comorbidity of malnutrition. There are emerging data that malnutrition, as reflected in body composition changes, impacts survival of cancer. However, not enough priority is given to nutrition management of children with cancer, particularly in LMICs. The primary purpose of this article is to review the current knowledge on childhood cancer and body composition in LMICs and identify priorities for future research into the interlinking associations between cancer, body composition, and clinical outcomes for childhood cancer patients. Evidence will ensure feasible and effective nutrition management is prioritized in childhood cancer centers in LMICs and contribute to improving outcomes for children with cancer.

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Section: Current Status Of Knowledgementioning

confidence: 99%

Perspective: Creating the Evidence Base for Nutritional Support in Childhood Cancer in Low- and Middle-Income Countries: Priorities for Body Composition Research

Murphy‐Alford

Prasad

Slone

et al. 2020

Advances in Nutrition

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“…Chemotherapy emetogenicity was classified using the 2019 POGO emetogenicity classification guideline where possible. 16 Where this was not possible, the American Society of Clinical Oncology (ASCO)'s emetogenicity classification was applied. 9 If classification was still not possible, the emetogenicity classification reported by study authors was accepted.…”

Section: Data Extractionmentioning

confidence: 99%

Dexamethasone dosing for prevention of acute chemotherapy‐induced vomiting in pediatric patients: A systematic review

Patel

Olteanu

Cabral

et al. 2020

Pediatric Blood & Cancer

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A systematic review was undertaken to describe dexamethasone doses studied for chemotherapy-induced vomiting (CIV) prophylaxis in pediatric patients and their effects on achieving complete acute CIV control. No dose-finding studies were identified. However, 16 studies assessing pediatric patients who received dexamethasone were included and classified according to the emetogenicity of chemotherapy administered. Eight different total daily dexamethasone doses were administered to patients on day 1 of highly emetogenic chemotherapy: three in conjunction with aprepitant/fosaprepitant plus a 5HT 3 antagonist and five in conjunction with a 5HT 3 antagonist. Five different total daily dexamethasone doses were administered in conjunction with a 5HT 3 antagonist to patients on day 1 of moderately emetogenic chemotherapy. Due to the heterogeneity of studies identified, meta-analysis was not possible. The optimal dexamethasone dose to control acute CIV and to minimize harms in pediatric patients remains uncertain. This is a key area for future research. K E Y W O R D S chemotherapy-induced nausea and vomiting, dexamethasone, pediatric oncology, supportive care 1 INTRODUCTION Chemotherapy-induced nausea and vomiting (CINV) are two of the most distressing side effects of chemotherapy. 1-3 They have a negative influence on quality of life, have been associated with decreased growth in children, and can lead to patients becoming nonadherent with oral chemotherapy and refusing to continue cancer treatment. 4-6 Dexamethasone has been included in pediatric CINV prophylaxis regimens for over three decades. 7 Current clinical practice guidelines (CPGs) for the prevention of acute CINV strongly recommend that pediatric patients receive dexamethasone in combination with Abbreviations: CINV, chemotherapy-induced nausea and vomiting; CIV, chemotherapy-induced vomiting; CPG, clinical practice guideline; HEC, highly emetogenic chemotherapy; MEC, moderately emetogenic chemotherapy aprepitant and a 5HT 3 antagonist during receipt of highly emetogenic chemotherapy (HEC) or in combination with a 5HT 3 antagonist during receipt of moderately emetogenic chemotherapy (MEC). 8-11 These CPGs acknowledge that there are circumstances when clinicians may wish to avoid the use of dexamethasone as an antiemetic and recommend alternatives. Such circumstances include brain tumors where corticosteroids may prevent chemotherapy distribution into the central nervous system 12 ; acute myelogenous leukemia where corticosteroids may further increase the already high risk of fungal infection 12 ; and use of chemotherapy where efficacy is compromised by concurrent corticosteroid use. 11 Nevertheless, inclusion of dexamethasone in pediatric CINV prophylaxis regimens and its appropriate dose are hotly debated among the pediatric oncology community. For example, two of 36 Children's Oncology Group member institutions responding to a survey in 2015 never administered dexamethasone for CIV

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“…The emetogenicity of chemotherapy drugs was classified according to the 2019 guideline for the classification of the acute emetogenic potential of antineoplastic medication in pediatric patients with cancer [17]. The emetogenic potential of anticancer drugs that are not described in this guideline was determined according to the 2011 guidelines [18].…”

Section: Chemotherapy Emetogenicity Assessmentmentioning

confidence: 99%

Efficacy of Olanzapine for High and Moderate Emetogenic Chemotherapy in Children

Lee

Kim

et al. 2020

Children

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This study was conducted to investigate the safety and efficacy of olanzapine for high and moderate emetogenic chemotherapy in children and young adults. We retrospectively reviewed the records of pediatric patients (n = 13) with cancer who had been administered olanzapine as an anti-emetic drug (AED) during a high and moderate emetogenic chemotherapy block from January 2018 to March 2020. Patients were administered other prophylactic AEDs according to practice guidelines. The mean age of the patients was 14.1 ± 5.5 years. The total number of chemotherapy cycles was 41. Twenty-one (51.2%) chemotherapy blocks were high emetogenic chemotherapy and 20 (48.8%) blocks were moderate emetogenic chemotherapy. Olanzapine was used for prophylaxis in 20 (48.8%) blocks of chemotherapy and rescue in 21 (51.2%). Of the 41 cycles, a complete response to olanzapine was achieved in 31 (75.6%), partial response in 6 (14.6%), and no response in 4 (9.8%). The mean dose was 0.07 ± 0.04 mg/kg/dose and 2.50 ± 1.37 mg/m2/dose. Adverse effects included somnolence, hyperglycemia, fatigue, and disturbed sleep. Our findings indicate that olanzapine was effective and safe for treating chemotherapy-induced nausea and vomiting in children. A prospective controlled study is needed to confirm these findings.

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Classification of the acute emetogenicity of chemotherapy in pediatric patients: A clinical practice guideline

Cited by 48 publications

References 17 publications

Perspective: Creating the Evidence Base for Nutritional Support in Childhood Cancer in Low- and Middle-Income Countries: Priorities for Body Composition Research

Perspective: Creating the Evidence Base for Nutritional Support in Childhood Cancer in Low- and Middle-Income Countries: Priorities for Body Composition Research

Dexamethasone dosing for prevention of acute chemotherapy‐induced vomiting in pediatric patients: A systematic review

Efficacy of Olanzapine for High and Moderate Emetogenic Chemotherapy in Children

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