Antiemetics in children receiving chemotherapy. MASCC/ESMO guideline update 2009

Abstract

Only a few studies have been carried out in children on the prevention of chemotherapy-induced nausea and vomiting (CINV). 5-HT 3 receptor antagonists have been shown to be more efficacious and less toxic than metoclopramide, phenothiazines and cannabinoids. Most dose studies are available for the 5-HT 3 receptor antagonists ondansetron and granisetron. The new 5-HT 3 receptor antagonist palonosetron was evaluated in one comparative study so far showing promising activity. Combinations of a 5-HT 3 receptor antagonist and dexamethasone showed increased efficacy with respect to a 5-HT 3 receptor antagonist alone. All paediatric patients receiving chemotherapy of high or moderate emetogenic potential should receive a combination of a 5-HT 3 receptor antagonist and dexamethasone to prevent acute emesis. No studies have specifically evaluated antiemetic drugs in the prevention of chemotherapy-induced delayed and anticipatory emesis in children. The role of the NK1 receptor antagonists in children has to be further investigated, although one small study is published so far, showing promising activity in the prevention of CINV with aprepitant. The new proposed guideline from the Multinational Association of Supportive Care in Cancer and the European Society of Clinical Oncology summarises the updated data from the literature and takes into consideration the existing guidelines.

Palonosetron versus ondansetron for prevention of chemotherapy-induced nausea and vomiting in paediatric patients with cancer receiving moderately or highly emetogenic chemotherapy: a randomised, phase 3, double-blind, double-dummy, non-inferiority study

“…[1][2][3] Adult patients in whom CINV is left uncontrolled experience a severe deterioration in their quality of life and may experience malnourishment, anxiety, and depression. Fear of CINV is sufficient for many patients to postpone or even refuse potentially life-saving treatment.…”

“…10,11 For patients undergoing a moderately emetogenic chemotherapy regimen, palonosetron hydrochloride (Aloxi®, palonosetron; a 5- In paediatric patients, at the time of study design, Multinational Association of Supportive Care in Cancer (MASCC) and European Society for Medical Oncology (ESMO) guidelines recommended prophylactic antiemetic therapy comprising a 5-HT 3 receptor antagonist and dexamethasone to prevent acute CINV in patients scheduled to receive moderately or highly emetogenic chemotherapy. 2 In later guidance, the Pediatric Oncology Group of Ontario (POGO) Guideline for the Prevention of Acute Nausea and Vomiting due to Antineoplastic Medication in Pediatric Cancer Patients recommended that children scheduled to receive highly emetogenic therapy should receive antiemetic prophylactic therapy of ondansetron or granisetron plus dexamethasone and aprepitant (≥12 years of age and receiving antineoplastic agents not known to interact with aprepitant) or ondansetron or granisetron plus dexamethasone (<12 years of age or receiving aprepitant interacting agents). 12 For patients scheduled to receive moderately emetogenic chemotherapy, the recommendation in the POGO guidelines is that patients should receive ondansetron or granisetron plus dexamethasone._ENREF_12…”

Palonosetron compared with ondansetron in pediatric cancer patients: multicycle analysis of a randomized Phase III study

“…conclusion: Over four cycles of HEC/ MEC, 20 μg/kg palonosetron was an efficacious and safe treatment for the prevention of chemotherapy-induced nausea and vomiting in pediatric cancer patients. Chemotherapy-induced nausea and vomiting (CINV) are common and distressing side effects in cancer patients receiving highly emetogenic chemotherapy (HEC) and moderately emetogenic chemotherapy (MEC) regimens [1,2]. CINV negatively impacts on patient quality of life [3], and can lead to medical complications and to noncompliance or premature discontinuation of anticancer therapy [4].…”

“…CINV negatively impacts on patient quality of life [3], and can lead to medical complications and to noncompliance or premature discontinuation of anticancer therapy [4]. It is recognized that children receiving chemotherapy are more prone to vomiting than adults, and it is estimated that 70% of pediatric cancer patients receiving chemotherapy will develop CINV [2].Prevention of CINV in adult cancer patients receiving HEC or MEC regimens can be achieved through the use of antiemetic agents, a combination of a 5-hydroxytryptamine-3 (5-HT 3 ) receptor antagonist, a corticosteroid and a neurokinin-1 (NK 1 ) receptor antagonist is recommended [5][6][7]. While fewer studies of these agents have been performed in pediatric cancer patients than in adults, at the time of the study design, the combination of a 5-HT 3 receptor antagonist with a corticosteroid was recommended for pediatric patients receiving HEC or MEC chemotherapy regimens [2,5,6].…”

“…It is recognized that children receiving chemotherapy are more prone to vomiting than adults, and it is estimated that 70% of pediatric cancer patients receiving chemotherapy will develop CINV [2].…”