2023 MASCC and ESMO guideline update for the prevention of chemotherapy- and radiotherapy-induced nausea and vomiting

Herrstedt, J.; Clark-Snow, R.; Ruhlmann, C.H.; Molassiotis, A.; Olver, I.; Rapoport, B.L.; Aapro, M.; Dennis, K.; Hesketh, P.J.; Navari, R.M.; Schwartzberg, L.; Affronti, M.L.; Garcia-Del-Barrio, M.A.; Chan, A.; Celio, L.; Chow, R.; Fleury, M.; Gralla, R.J.; Giusti, R.; Jahn, F.; Iihara, H.; Maranzano, E.; Radhakrishnan, V.; Saito, M.; Sayegh, P.; Bosnjak, S.; Zhang, L.; Lee, J.; Ostwal, V.; Smit, T.; Zilic, A.; Jordan, K.; Scotté, F.

doi:10.1016/j.esmoop.2023.102195

Cited by 23 publications

(4 citation statements)

References 98 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…However, with the maturation of real-world experience suggesting an inadequate nausea control with the two-drug prophylaxis in a non-negligible proportion of patients ( 13 , 14 ), in January 2023, the NCCN guidelines re-categorized T-DXd as a highly emetogenic agent, modifying the recommendation to endorse a three-drug antiemetic regimen for all patients ( 15 ). In January 2024, the ESMO guidelines have incorporated explicit recommendations for the management of T-DXd-related nausea and vomiting, categorizing it as a pharmaceutical agent at the high end of the moderate category ( 16 ). The recommendations advise the implementation of a three-drug regimen that includes an NK1RA, aligning with the established approach for Carboplatin with AUC ≥5 ( 16 ).…”

Section: Discussionmentioning

confidence: 99%

“…In January 2024, the ESMO guidelines have incorporated explicit recommendations for the management of T-DXd-related nausea and vomiting, categorizing it as a pharmaceutical agent at the high end of the moderate category ( 16 ). The recommendations advise the implementation of a three-drug regimen that includes an NK1RA, aligning with the established approach for Carboplatin with AUC ≥5 ( 16 ).…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Management of Trastuzumab Deruxtecan-related nausea and vomiting in real-world practice

Notini,

Naldini,

Sica

et al. 2024

Front. Oncol.

View full text Add to dashboard Cite

BackgroundNausea and vomiting are common side effects of Trastuzumab Deruxtecan (T-DXd), but guidelines for optimal management were not initially available. This retrospective single-center study aimed at evaluating the efficacy of two antiemetic regimens in patients receiving T-DXd.MethodsData from metastatic breast cancer patients receiving T-DXd were collected. Two groups were defined: patients treated with 5-HT3 receptor antagonists (RA) ± dexamethasone (5-HT3-group) and patients treated with a fixed oral combination of netupitant (NK1RA) and palonosetron ± dexamethasone (NK1 group). Physicians preferentially offered the NK1 regimen to patients at higher risk of nausea and vomiting based on internal recommendations. Only nausea and vomiting during cycles 1 and 2 were considered. Comparisons of nausea and vomiting by the antiemetic prophylaxis group were assessed using chi-square.ResultsA total of 53 patients were included in the analysis. At cycle 1, 72% and 28% of patients received the 5-HT3 and NK1 prophylaxis, respectively. Overall, 58% reported nausea, with no differences between groups (58% vs. 60%; p = 0.832), but with a trend for lower grade in the NK1 group (33.3% G1; 26.7% G2) compared to the 5-HT3 group (23.7% G1; 31.6% G2; 2.6% G3). Vomiting was reported by 21% and 0% of patients in the 5-HT3 and the NK1 group, respectively (p = 0.054). Among the 15 patients in the 5-HT3 group with nausea at cycle 1 who escalated to NK1 at cycle 2, nausea decreased from 100% to 53% (p = 0.022) and vomiting decreased from 47% to 13% (p = 0.046).ConclusionsThe NK1 regimen improved vomiting control at cycle 1 and, when introduced at cycle 2, significantly improved both nausea and vomiting. The biased NK1 selection for higher-risk patients may have dampened the differences between groups at cycle 1. These findings support enhanced control of T-DXd-related nausea and vomiting with NK1RA.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Management of Trastuzumab Deruxtecan-related nausea and vomiting in real-world practice

Notini,

Naldini,

Sica

et al. 2024

Front. Oncol.

View full text Add to dashboard Cite

show abstract

“…Due to the degree of vomiting induced by diverse chemotherapeutic drugs, CINV includes acute vomiting and delayed vomiting. Acute vomiting occurs within 24 h after chemotherapy, whereas delayed vomiting occurs after 24 h ( Herrstedt et al, 2024 ). CINV can result in anxiety, depression, and other negative emotions in patients; significantly reduce their quality of life ( Farrell et al, 2013 ); and even develop serious metabolic complications, such as hyponatremia, hypokalemia, and metabolic acidosis, affecting the therapeutic effect ( Miao et al, 2017 ).…”

Section: Introductionmentioning

confidence: 99%

The efficacy and safety of Xiao-Ban-Xia-Tang in the treatment of chemotherapy-induced nausea and vomiting: A systematic review and meta-analysis

Li,

Jia,

et al. 2024

Front. Pharmacol.

View full text Add to dashboard Cite

BackgroundChemotherapy-induced nausea and vomiting (CINV) is one of the most frequent and critical side effects due to chemotherapeutics. In China, Xiao-Ban-Xia-Tang (XBXT) has already been applied extensively to prevent and treat CINV. However, there is limited testimony on the effectiveness and safety of this purpose, and there was no correlative systematic review. The aim of this review was to systematically evaluate the effectiveness and safety of XBXT in preventing and treating CINV.MethodsThe systematic search was conducted in eight databases to acquire randomized controlled trials (RCTs) that appraised the effect of XBXT in treating CINV. The vomiting and nausea relief efficiency, eating efficiency, quality of life, and adverse reactions were explored for efficacy assessment. Bias risk was rated by manipulating the Cochrane risk of bias tool 2.0 (RoB 2). The retrieved investigations were analyzed by utilizing ReviewManager 5.4 and Stata 17.0. The quality of evidence was evaluated adopting the GRADE tool.ResultsA total of 16 clinical RCTs of XBXT in the treatment of CINV were incorporated into the investigation, with a total of 1246 participants. The meta-analysis showed that compared with conventional antiemetic drugs, XBXT and antiemetics improved the vomiting relief efficiency (RR 1.35, 95% confidence interval: 1.25–1.46, p < 0.00001), nausea relief efficiency (N = 367, RR 1.23, 95% CI: 1.09–1.38, p < 0.00001), and quality of life (RR = 1.37, 95% CI: 1.14–1.65, p = 0.0009) and reduced the adverse events (N = 370, RR 0.53, 95% CI: 0.29–0.96, p = 0.04). XBXT and DARAs raised eating efficiency compared with DARAs (N = 208, RR 1.30, 95% CI: 1.07–1.57, p = 0.007). The data existed as statistically significant, and the publication bias was identified as relatively low from the funnel plot and trim and fill analysis. In addition, sensitivity analysis demonstrated robust outcomes. The quality of evidence for each outcome ranged from moderate to high.ConclusionThere is some encouraging evidence that XBXT and antiemetics had better therapeutic effects and safety in treating CINV than antiemetic drugs alone. The quality assessment and low publication bias indicated that the overall criterion was scientific. Better research is required to verify the evidence designed with large-scale RCTs and rigorous methods.Systematic Review Registration:https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=281046.

show abstract

“…3 The commonly used antiemetic guidelines have some differences with respect to the antiemetic prophylaxis (AEP) agent to be considered for oxaliplatin-and carboplatin-containing regimens. 2,4,5 The European Society for Medical Oncology (ESMO) antiemetic guidelines suggest adding a neurokinin-1 receptor antagonist (NK-1RA) for women younger than 50 years receiving oxaliplatin-containing regimens and also set a cutoff of carboplatin (area under the receiver operating characteristic curve [AUC]Ն5) for using a similar 3-drug AEP. In contrast, the American Society of Clinical Oncology guidelines set a cutoff of carboplatin (AUCՆ4) for use of 3-drug AEP besides having no additional recommendations for use of oxaliplatin.…”

Section: Introductionmentioning

confidence: 99%

Olanzapine as Antiemetic Prophylaxis in Moderately Emetogenic Chemotherapy

Ostwal,

Ramaswamy,

Mandavkar

et al. 2024

JAMA Netw Open

View full text Add to dashboard Cite

ImportanceThe role of olanzapine has not been adequately evaluated in moderately emetogenic chemotherapy (MEC) regimens with or without neurokinin-1 receptor antagonists.ObjectiveTo evaluate whether addition of olanzapine to an MEC regimen reduces nausea, vomiting, and use of nausea rescue medications among patients with solid malignant tumors.Design, Setting, and ParticipantsThis multicenter, open-label phase 3 randomized clinical trial included patients aged 18 years or older with solid malignant tumors who were receiving oxaliplatin-, carboplatin-, or irinotecan-based chemotherapy. The trial was conducted at 3 institutes in India from March 26, 2019, to August 26, 2023; the final cutoff date for analysis was September 10, 2023.ExposurePatients were randomized 1:1 to dexamethasone, aprepitant, and palonosetron with olanzapine (experimental group) or without olanzapine (observation group). The experimental group received 10 mg of olanzapine orally once at night on days 1 through 3 of the chemotherapy regimen.Main Outcomes and MeasuresThe primary end point was complete response (CR), defined as the proportion of patients with no vomiting, no significant nausea (scored as &lt;5 on a visual analog scale of 1 to 100), and no use of rescue medications for nausea. Secondary end points included the proportion of patients experiencing nausea and chemotherapy-induced nausea and vomiting (CINV), receiving rescue medications, and experiencing adverse events.ResultsA total of 560 patients (259 [64%] male; median age, 51 years [range, 19-80 years]) were randomized. The analysis included 544 patients with evaluable data (274 assigned to olanzapine and 270 to observation). Baseline characteristics were evenly matched between the 2 groups. The proportion of patients with CR was significantly greater in the group with (248 [91%]) than without (222 [82%]) olanzapine in the overall 120-hour treatment period (P = .005). Likewise, there were significant differences between the olanzapine and observation groups for nausea control (264 [96%] vs 234 [87%]; P &lt; .001) and CINV (262 [96%] vs 245 [91%]; P = .02) during the overall assessment period, and the proportion of patients receiving rescue medications significantly increased in the observation group (30 [11%]) compared with the olanzapine group (11 [4%]) (P = .001). Grade 1 somnolence was reported by 27 patients (10%) following administration of chemotherapy and olanzapine and by no patients in the observation group.Conclusions and RelevanceIn this randomized clinical trial, the addition of olanzapine significantly improved CR rates as well as nausea and vomiting prevention rates in chemotherapy-naive patients who were receiving MEC regimens containing oxaliplatin, carboplatin, or irinotecan. These findings suggest that use of olanzapine should be considered as one of the standards of care in these chemotherapy regimens.Trial RegistrationClinical Trials Registry–India (CTRI) Identifier: CTRI/2018/12/016643

show abstract

2023 MASCC and ESMO guideline update for the prevention of chemotherapy- and radiotherapy-induced nausea and vomiting

Cited by 23 publications

References 98 publications

Management of Trastuzumab Deruxtecan-related nausea and vomiting in real-world practice

Management of Trastuzumab Deruxtecan-related nausea and vomiting in real-world practice

The efficacy and safety of Xiao-Ban-Xia-Tang in the treatment of chemotherapy-induced nausea and vomiting: A systematic review and meta-analysis

Olanzapine as Antiemetic Prophylaxis in Moderately Emetogenic Chemotherapy

Contact Info

Product

Resources

About