Antiemetic guidelines: creating a more practical treatment approach

Abstract

Antiemetic guidelines from a variety of professional organizations have been available for several years. It is unclear just how often these guidelines have been used, however; data indicate that some practitioners still do not treat their patients according to the recommendations. Some of those involved in the creation of the original guidelines convened to try to create a simpler, more practical approach to the use of antiemetics in preventing chemotherapy-induced nausea and vomiting. The group's intention was to clarify available guidelines and produce a practical document, based on evidence, that could be used in everyday practice. The group created four consensus statements that would serve as a basis for their recommendations. One primary strategy used was to have chemotherapy-induced nausea and vomiting viewed as a single process that can occur throughout a treatment cycle, and not so much as an acute and a delayed process, as is usual in clinical trials. Patients' management should be considered over a 4- to 5-day period, rather than primarily dealing with the day of treatment only. The group created three tables: emetic risk of chemotherapy; treatment options based on emetic category; and antiemetic dosing recommendations. Use of these tables should make appropriate antiemetic selection more straightforward and easier for the practitioner in an everyday setting. Although this document alone may not solve all the challenges with appropriate antiemetic management, it will hopefully prove to be a step in the right direction.

Chemotherapy-Induced Nausea and Vomiting: The Importance of Acute Antiemetic Control

“…5-HT 3 -receptor antagonists have become the agents of choice in preventing acute CINV following both moderately and highly emetogenic chemotherapy [11,51]. Complete response and total control rates seen with specific drugs range from 60%-80% for moderately emetogenic chemotherapy [4,[52][53][54], 40%-60% for cisplatin-containing therapy [4,33,55,56], and 25%-60% for high-dose cisplatin regimens [33,35,47,57,58].…”

“…In all patients receiving cisplatin, a corticosteroid plus a 5-HT 3 -receptor antagonist is recommended for the prevention of delayed and anticipatory CINV. In patients receiving high-risk, non-cisplatin regimens, a prophylactic corticosteroid with or without either a 5-HT 3 -receptor antagonist or metoclopramide is suggested [11,51]. Overall, the prophylactic use of the most effective antiemetic regimen appropriate to the chemotherapy employed is suggested to prevent acute, delayed, and anticipatory nausea and vomiting.…”

Improved prevention of moderately emetogenic chemotherapy‐induced nausea and vomiting with palonosetron, a pharmacologically novel 5‐HT3 receptor antagonist

“…Therefore, according to current evidence-based guidelines (American Society of Clinical Oncology, Multinational Association of Supportive Care in Cancer) and consensus guidelines (American Society of Health-System Pharmacists, National Comprehensive Cancer Network), these 5-HT 3 receptor antagonists are considered therapeutically equivalent and interchangeable when used at equipotent doses. [3][4][5][6][7] Although 5-HT 3 receptor antagonists are part of the current standard of care for patients receiving chemotherapy, a substantial proportion of patients today continue to experience both acute and particularly delayed CINV after moderately or highly emetogenic chemotherapy. 7,8 Therefore, there is still a need to develop new agents to improve control rates and patient care.…”

Hypnosis in Cancer Patients: Can We Do Better?

“…A universally effective anti-emetic medication remains elusive (Koeller, 2002), although important advances have been made. Complementary approaches are therefore interesting, especially for anticipatory symptoms.…”