Prevention of acute and delayed chemotherapy‐induced nausea and vomiting in pediatric cancer patients: A clinical practice guideline

Abstract

This clinical practice guideline provides recommendations for preventing acute and delayed phase chemotherapy‐induced nausea and vomiting (CINV) in pediatric patients. The recommendations are based on two systematic reviews of randomized controlled trials evaluating interventions to prevent (1) acute phase CINV and (2) delayed phase CINV. Recommendations for acute phase and delayed phase CINV prophylaxis are made for patients receiving chemotherapy of varying emetogenicity, as well as for patients not able to receive dexamethasone or a neurokinin‐1 receptor antagonist. Evidence gaps, including antiemetic safety and optimal dosing, were identified.

Treatment of breakthrough and prevention of refractory chemotherapy‐induced nausea and vomiting in pediatric cancer patients: Clinical practice guideline update

“…This CPG provides up‐to‐date recommendations for the treatment of breakthrough CINV and prevention of refractory CINV in pediatric cancer patients. Coupled with the recommendations of the other CPGs in this series, 1,3,4 their implementation will optimize CINV control in pediatric patients.…”

“…While intended as an update of the original 2016 CPG, the inclusion criteria for the systematic reviews to inform this CPG were revised to align with those performed to underpin the recently published acute and delayed CINV prophylaxis CPG 1,6 . Thus, a de novo approach to CPG recommendation development was taken.…”

“…Those randomized to palonosetron were significantly more likely to experience a greater than 50% reduction in nausea score at 24 hours compared to continuous intravenous ondansetron (62% vs. 17%; p = .008). To make this recommendation, the panel also drew on the systematic review used to inform the 2022 CPG for prevention of acute and delayed CINV 1,6 . Compared to other serotonin‐3 receptor antagonists (5HT3RAs), palonosetron was associated with a higher likelihood of complete control of acute CIV in the absence of a neurokinin‐1 receptor antagonist (NK1RA), and complete control of delayed CIV and delayed CIN.…”

“…Despite the use of clinical practice guideline (CPG)‐consistent antiemetic prophylaxis for acute and delayed chemotherapy‐induced nausea and vomiting (CINV), 1 pediatric patients receiving chemotherapy may experience breakthrough CINV. Patients with breakthrough CINV may then develop refractory CINV during future chemotherapy blocks.…”

“…This CPG is an update of the 2016 version 2 . It is one of a series of CPGs 1,3,4 developed by the Pediatric Oncology Group of Ontario's (POGO's) Guideline Program that are focused on the prevention and treatment of CINV in pediatric patients less than 18 years old with cancer or undergoing hematopoietic stem cell transplant (HSCT). This CPG aims to provide clinicians (physicians, nurse practitioners, physician assistants, nurses, pharmacists, and others) who care for children and adolescents with cancer or undergoing HSCT with up‐to‐date recommendations for treatment of breakthrough and prevention of refractory CINV.…”