The Multinational Association of Supportive Care in Cancer (MASCC) and the European Society for Medical Oncology (ESMO) have updated their 2009 consensus recommendations for the prevention of acute chemotherapy-induced nausea and vomiting (CINV) in pediatric patients with cancer.1
Key recommendations of the 2016 guidelines include:
• For children receiving high or moderately emetogenic chemotherapy, prophylaxis for acute CINV should include a 5HT3 antagonist (eg, granisetron, ondansetron, palonosetron) with or without dexamethasone and/or aprepitant.
• For children receiving low emeotgenic chemotherapy, a 5HT3 antagonist alone is recommended.
• For children receiving chemotherapy of minimal emetogenicity should not receive CINV prophylaxis.
Of note, young children who are unable to swallow oral solid dosage forms or children whose weight does not allow appropriate dosing with the oral solid dosage forms available may be unable to receive aprepitant. Fosaprepitant, the intravenous formulation of aprepitant, cannot be routinely recommended currently due to a lack of pediatric experience with this agent.
These recommendations were based on an original literature review of 25 randomized studies, including 8 published since 2009, that evaluated CINV prophylaxis in children younger than 18 years.
Despite new data, significant research gaps remain that must be addressed in order to optimize control of CINV in children.
1. Dupuis LL, Sung L, Molassiotis A, Orsey AD, Tissing W, van de Wetering M. 2016 updated MASCC/ESMO consensus recommendations: Prevention of acute chemotherapy-induced nausea and vomiting in children. Supp Care Cancer. 2016 Aug 26. doi: 10.1007/s00520-016-3384-y. [Epub ahead of print]