Recommendations for the Use of Antiemetics: Evidence-Based, Clinical Practice Guidelines

Gralla, Richard J.; Osoba, David; Kris, Mark G.; Kirkbride, Peter; Hesketh, Paul J.; Chinnery, Lawrence W.; Clark‐Snow, Rebecca; Gill, David P.; Groshen, Susan; Grunberg, Steven M.; Koeller, James M.; Morrow, Gary R.; Perez, Edith A.; Silber, Jeffrey H.; Pfister, David G.

doi:10.1200/jco.1999.17.9.2971

Cited by 619 publications

(463 citation statements)

References 211 publications

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“…Multiple clinical guidelines including Chinese antiemetic guidelines (2014 version) have recommended antiemetic therapy for HEC consisting of NK‐1R triple regimen (Gralla et al., 1999; Shiying, Jiliang, & Shukui, 2014; Tageja & Groninger, 2016). Aprepitant was the first potent and selective NK1 RA and was also approved for the prevention of CINV by CFDA in China.…”

Section: Discussionmentioning

confidence: 99%

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Efficacy and safety of fosaprepitant in the prevention of nausea and vomiting following highly emetogenic chemotherapy in Chinese people: A randomized, double-blind, phase III study

et al. 2017

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The prevention of chemotherapy‐induced nausea and vomiting was one of the most challenging supportive care issues in oncology, especially to highly emetogenic chemotherapy (HEC). A total of 645 patients were randomized into fosaprepitant group (fosaprepitant/placebo 150 mg d1 in combination with granisetron and dexamethasone) or aprepitant group (aprepitant/placebo 125 mg d1; 80 mg d2‐d3 plus granisetron and dexamethasone).The primary endpoint was the percentage of patients who had a complete response (CR) over the entire treatment course (0–120 hr, overall phase [OP]). It was assessed by using a non‐inferiority model, with a non‐inferiority margin of 10%. The difference of the CR rate was compared between two groups with chi‐square analysis. Six hundred and twenty‐six patients were included in the per protocol analysis. The percentage of patients with a CR in the fosaprepitant group was not inferior to that in the aprepitant group (90.85% versus 94.17%, p = .1302) during OP. Whether the cisplatin‐based chemotherapy or not, the CR rate of the fosaprepitant group was not inferior to that of the aprepitant group. Both regimens were well tolerated. The most common adverse event was constipation. Fosaprepitant provided effective and well‐tolerated control of nausea and vomiting associated with HEC in Chinese patients.

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Section: Discussionmentioning

confidence: 99%

“…There has been substantial progress in improving the control of CINV since the serotonin 5‐hydroxytryptamine (5‐HT 3 ) receptor antagonists (RAs)were developed in the 1990s (Gralla et al., 1999). Nevertheless, patients who received HEC but are still suffering from CINV constitute a difficult‐to‐treat group.…”

Section: Introductionmentioning

confidence: 99%

Efficacy and safety of fosaprepitant in the prevention of nausea and vomiting following highly emetogenic chemotherapy in Chinese people: A randomized, double-blind, phase III study

et al. 2017

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“…In some cases, a wish to reduce prescription cost [1] may result in the choice of a cheaper alternative. The low utilisation of 5-HT 3 antagonists is not in line with evidence-based suggestions for this patient group, both in older [19,21,35] and in more recently updated antiemetic guidelines based on randomised controlled studies [17,27,31]. During upper abdominal irradiation, it has been shown that a 5-HT 3 antagonist given prophylactic (43% had nausea) was more effective than placebo (58% had nausea) [28] and was more effective than corticosteroids only [40].…”

Section: Discussionmentioning

confidence: 95%

One third of patients with radiotherapy-induced nausea consider their antiemetic treatment insufficient

Enblom

Axelsson

Steineck

et al. 2008

Support Care Cancer

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Objective To describe the prevalence of nausea and vomiting during radiotherapy and to compare quality of life, psychological and functional status in patients experiencing or not experiencing nausea.Materials and methods A cross-sectional selection of 368 cancer patients treated with radiotherapy answered a questionnaire (=93% answering rate) regarding nausea, vomiting, actual use of and interest in antiemetic treatment, quality of life and psychological and functional status during the preceding week of radiotherapy. Mean age was 60 years and 66% were women. Main results Nausea was experienced by 39% (145) and vomiting by 7% (28) of patients in general, by 63% in abdominal or pelvic fields and by 48% in head/neck/brain fields. Abdominal/pelvic field (Relative risk (RR) 2.0), age ≤40 years (RR 1.9) and previous nausea in other situations (RR 1.8) implied an increased risk for nausea. Antiemetics were used by 17% and 78% were interested in or wanted more information about acupuncture treatment against nausea. Of the 145 nauseous patients only 25% felt that antiemetics had helped them and 34% would have liked additional treatment, although the nausea intensity was mild in 72%. The nauseous patients reported lower well-being and quality of life, lower satisfaction with aspects of daily living and more frequent anxiety and depressed mood than the patients without nausea. Conclusions Of all patients undergoing radiotherapy, 39% experienced nausea and one third of them would have liked more treatment against the nausea. This study stresses the importance to identify and adequately treat patients with increased risk for nausea related to radiotherapy.

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“…Just before the beginning of accrual and during the course of this study, guidelines for the prevention of delayed emesis were published by the National Comprehensive Cancer Network, 12 the Multinational Association of Supportive Care in Cancer, 13 and the American Society of Clinical Oncology. 14 The evidence and degree of consensus for these guidelines were moderate at best and they were considered to be voluntary for practicing physicians, who were encouraged to use their clinical judgment in each case. 14 Unfortunately, because we did not assess the amount and type of antiemetic medications given during the delayed phase of this study, we cannot say how closely they approximated current guidelines.…”

Section: Discussionmentioning

confidence: 99%

“…14 The evidence and degree of consensus for these guidelines were moderate at best and they were considered to be voluntary for practicing physicians, who were encouraged to use their clinical judgment in each case. 14 Unfortunately, because we did not assess the amount and type of antiemetic medications given during the delayed phase of this study, we cannot say how closely they approximated current guidelines. We believe that the frequency and severity of DN would be lower than we have reported if physicians follow current recommended practices.…”

Section: Discussionmentioning

confidence: 99%

Nausea and emesis remain significant problems of chemotherapy despite prophylaxis with 5‐hydroxytryptamine‐3 antiemetics

Hickok

Roscoe

Morrow

et al. 2003

Cancer

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184

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BACKGROUNDClinical reports suggest that nausea remains a side effect of chemotherapy despite widespread use of serotonin receptor antagonists. This study summarized the frequency, timing, and intensity of postchemotherapy nausea for patients receiving doxorubicin, cisplatin, or carboplatin.METHODSThree hundred sixty chemotherapy‐naïve patients (73% female) were enrolled in a study testing the ability of an information intervention to reduce nausea. Of these, 322 subjects completed the Morrow Assessment of Nausea and Emesis (MANE), as well as a 5‐day self‐report diary, at Cycle 1 (300 subjects completed the MANE and self‐report diary at Cycle 2). All patients received a 5‐hydroxytryptamine‐3 receptor antagonist (ondansetron) with dexamethasone on the day of treatment.RESULTSSeventy‐six percent of the patients developed nausea during the 5‐day period, beginning with the Cycle 1 infusion, and 73% of patients reported delayed nausea (DN) during Days 2–5. The proportions were similar during Cycle 2. Fifty‐five percent of patients described their DN as being of moderate or greater intensity compared with 28% of patients who described acute nausea. Carboplatin was less likely to cause DN than either of the other agents (56% of 106 patients compared with 75% of 47 receiving cisplatin and 83% of 169 taking doxorubicin). The mean peak DN severity was 4.34 (range, 1–7) for doxorubicin, which was significantly higher than the mean peak value for carboplatin (3.66) but was not significantly different from the mean peak value for cisplatin (4.26). Eighteen percent of patients did not experience nausea until Day 3 or later.CONCLUSIONSDespite prophylaxis with ondansetron, the majority of patients receiving one of these common chemotherapy agents experienced nausea. The frequency of DN was nearly twice that of acute nausea. Results show the need for continued development of antiemetics that are effective against DN. Cancer 2003;97:2880–6. © 2003 American Cancer Society.DOI 10.1002/cncr.11408

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Recommendations for the Use of Antiemetics: Evidence-Based, Clinical Practice Guidelines

Cited by 619 publications

References 211 publications

Efficacy and safety of fosaprepitant in the prevention of nausea and vomiting following highly emetogenic chemotherapy in Chinese people: A randomized, double-blind, phase III study

Efficacy and safety of fosaprepitant in the prevention of nausea and vomiting following highly emetogenic chemotherapy in Chinese people: A randomized, double-blind, phase III study

One third of patients with radiotherapy-induced nausea consider their antiemetic treatment insufficient

Nausea and emesis remain significant problems of chemotherapy despite prophylaxis with 5‐hydroxytryptamine‐3 antiemetics

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