Emesis induced by low or minimal emetic risk chemotherapy

Abstract

For patients treated with low or minimally emetogenic chemotherapy there is little evidence from clinical trials supporting the choice of a given antiemetic therapy or of any treatment at all. The panel recognized the necessity of considering the introduction into clinical practice of new agents in these categories, particularly oral cytotoxic agents and targeted biological agents and also the possibility of over-treatment with antiemetics. There was consensus among panel members regarding the recommended treatment for patients receiving chemotherapy agents with low and minimal emetic risk. Patients without a history of nausea and vomiting for whom minimally emetic risk chemotherapy is prescribed should not routinely receive antiemetic prophylaxis. A single agent such as a low-dose corticosteroid is suggested for patients receiving agents of low emetic risk. If nausea and vomiting occurs during subsequent cycles of chemotherapy, prophylaxis with a single agent such as a substituted benzamide, a corticosteroid, or a phenothiazine should be administered. Only patients with persistent nausea and vomiting despite treatment with these recommended agents should receive a 5-HT3 receptor antagonist in the following cycles.

A prospective observational study of chemotherapy-related nausea and vomiting in routine practice in a UK cancer centre

“…An assessment took place as to whether the antiemetics presented in Table 2 met international clinical guidelines (ASCO or MASCC) [13,17]. Any prescription that included the antiemetic medication(s) recommended by clinical guidelines was deemed to follow such guidelines, with the exception of HEC antiemetic protocols, which were compared with older guidelines [26], as aprepitant is not prescribed in much of UK's National Health Service.…”

“…Little attention has been paid to low or minimally emetogenic chemotherapy, and therefore, this area has been seen as a research priority [13]. With the advent of a newer generation of 5-HT 3 receptor antagonists and NK 1 antagonists, it has become unclear how much of a problem CINV is in current clinical practice.…”

Risk factors at pretreatment predicting treatment-induced nausea and vomiting in Australian cancer patients: a prospective, longitudinal, observational study

“…chemoradiation) that patients have increasingly received in recent years. Additionally, those examining chemotherapy-induced NV often did so after a single cycle rather than multiple cycles [25] and focused on moderately/highly emetogenic chemotherapy [12][13][14][15][16][17] to the exclusion of minimally/low emetogenic chemotherapy [25,30]. Finally, few published studies have investigated TINV outside of randomised controlled trial (RCT) settings [14,27].…”

An oral history of MASCC, its origin and development from MASCC's beginnings to 2009

“…The first published guidelines were in the areas of infection and febrile neutropenia. MASCC published the first ever Antiemetic Guidelines in 1998, which were updated in 2004 [9][10][11][12][13][14][15][16][17][18] and 2009. The MASCC Antiemesis Tool was released in 2004 to assist patients and oncology professionals in communicating accurately about the prevention and control of nausea and vomiting that may occur with chemotherapy.…”