The Multinational Association of Supportive Care in Cancer (MASCC) and the European Society for Medical Oncology (ESMO) have issued an update to their joint recommendations for the prevention of nausea and vomiting following multiple-day chemotherapy and high-dose chemotherapy, and for breakthrough nausea and vomiting.1
Key recommendations from the 2016 updated MASCC/ESMO consensus recommendations include:
• For patients receiving high-dose chemotherapy with hematopoietic stem cell transplantation (HSCT), a 5-HT3 receptor antagonist with dexamethasone and aprepitant (125 mg orally on day 1 and 80 mg orally on days 2 to 4) is recommended prior to chemotherapy.
• For patients undergoing multiple-day chemotherapy-induced, a 5-HT3 receptor antagonist, dexamethasone, and aprepitant are recommended prior chemotherapy for the prevention of acute emesis and delayed emesis.
• For patients experiencing breakthrough nausea and vomiting, the available evidence suggests the use of olanzapine 10 mg orally daily for 3 days; however, mild to moderate sedation with this agent may be problematic in this patient population (especially older patients).
To formulate these updates, investigators conducted a systematic literature and identified 3 phase 3 randomized trials in patients undergoing high-dose chemotherapy and HSCT and 8 single-arm in patients undergoing HSCT and in those receiving multiple-day chemotherapy.
For patients receiving treatment for breakthrough CINV, investigators also identified a phase 3 randomized trial evaluating the use of olanzapine vs metoclopramide in patients receiving highly emetogenic chemotherapy and a single-arm study investigating the effectiveness of olanzapine.
Two randomized clinical trials were ultimately used for this guideline update.
1. Einhorn LH, Rapoport B, Navari RM, Herrstedt J, Brames MJ. 2016 updated MASCC/ESMO consensus recommendations: prevention of nausea and vomiting following multiple-day chemotherapy, high-dose chemotherapy, and breakthrough nausea and vomiting. Supp Care Cancer. 2016 Nov 4. doi: 10.1007/s00520-016-3449-y. [Epub ahead of print]