Identifying an optimal antiemetic regimen for patients receiving anthracycline and cyclophosphamide-based chemotherapy for breast cancer – An inspection of the evidence base informing clinical decision-making

Control of Nausea and Vomiting in Patients Receiving Anthracycline/Cyclophosphamide Chemotherapy for Breast Cancer

“…The rates of control of CINV during overall period observed in the present study were generally consistent with those reported by other investigators in breast cancer patients receiving AC chemotherapy: the complete response rate was similar to the data (47%) by Yeo et al (12), that (50%) by Hesketh et al (14) and within a range (36-82%) reported by others (8,11,13,15,22,23). The rates of no nausea and no vomiting were also within the range reported by other investigators [31-49% for nausea (8)(9)(10)(11)(12); 55-92% for vomiting (9-12, 13-16)].…”

“…However, the control of CINV associated with AC chemotherapy is not necessarily sufficient, even when the guideline-consistent three-drug antiemetic premedication is implemented. Particularly, the rate of no nausea is too low (31-49%) (8)(9)(10)(11)(12) compared to the rate of no vomiting (55-92%) (9)(10)(11)(12)(13)(14)(15)(16). We also previously reported that AC chemotherapy for breast cancer is most emetogenic among various chemotherapy regimens that were carried out in the outpatient setting, in which the odds ratio (OR) for incidence of CINV is 4.955 [95% confidence interval (CI)=1.863-13.18; p=0.001] (17).…”

A randomized trial of individualized versus standard of care antiemetic therapy for breast cancer patients at high risk for chemotherapy-induced nausea and vomiting

“…Approximately 70% of breast cancer patients still have uncontrolled chemotherapy-induced nausea and vomiting (CINV) and nausea in particular, even after “optimal guideline-directed” antiemetic therapy [ 1 , [7] , [8] , [9] , [10] , [11] ]. Regardless, most CINV trials continue to use vomiting-related endpoints as their primary study outcome [ 7 , [12] , [13] , [14] ]. In addition, despite significant variability in individual patient risk and the availability of validated models that can prospectively identify patents at high personal risk of CINV [ [15] , [16] , [17] , [18] , [19] ], most studies continue to use type of chemotherapy regimen as their defining factor for CINV risk.…”

A cost-utility analysis of risk model-guided versus physician’s choice antiemetic prophylaxis in patients receiving chemotherapy for early-stage breast cancer: a net benefit regression approach

“…Despite practice-based guidelines recommending that all patients receive an antiemetic combination containing a neurokinin-1 (NK-1) receptor antagonist, it is evident from international data that adherence to these guidelines is not optimal [9][10][11] and that clinical practice globally is much more variable than the guidelines would suggest. The reasons for this are likely multifactorial but include the relatively high cost of NK1 inhibitors [12] and the fact that no optimal antiemetic regimen has been identified for patients receiving cyclophosphamide with anthracycline-based chemotherapy [5,13].…”