Patients treated with emetogenic cancer chemotherapy should receive a four-drug antiemetic regimen, according to an updated clinical guideline published in the Journal of Clinical Oncology (online July 31, 2017; doi:10.1200/JCO.2017.74.4789).
The American Society of Clinical Oncology (ASCO) convened an expert panel to update their guidelines for antiemetic use in oncology. The panel conducted a systematic review of recent medical literature from November 2009 to June 2016. A total of 41 publications were included in the review.
A major update to the guidelines involves the addition of olanzapine to a standard three-drug antiemetic regimen (including a 5-HT3 receptor antagonist, a neurokinin-1 receptor antagonist, and dexamethasone) for adults who receive high-emetic-risk antineoplastic agents or who report nausea and vomiting. This recommendation came following results of a phase III randomized controlled trial, which demonstrated that adding olanzapine to antiemetic prophylaxis helps reduce the likelihood of nausea among adult patients.
Other featured updates include a recommendation to administer dexamethasone at baseline for patients who receive anthracycline and cyclophosphamide chemotherapy, as well as 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.
Changes were enacted to anatomic regions, risk levels, and antiemetic administration scheduled for radiation-induced nausea and vomiting. For low-emetic-risk radiation therapy, rescue therapy alone is suggested.
The panel asserts the importance of using the most effective antiemetic regimens that are appropriate for antineoplastic agents or administered radiotherapy. Regimens deemed most effective should be used with initial treatment, rather than after assessing emetic responses with less-effective treatments.
"The adverse impact of inadequately controlled nausea and vomiting on patients' quality of life is well documented," said Paul J Hesketh, MD, guideline panel co-chair, Lahey Clinic (Burlington, MA), in an interview (July 31, 2017). "By following the ASCO antiemetics guideline, clinicians have the opportunity to improve patients' quality of life by minimizing treatment-induced emesis."—Zachary Bessette