guidelines for chemotherapy induced nausea and vomiting
TRANSCRIPT
Chemotherapy Induced Nausea and Vomiting
By
Osama ElzaafaranyAssistant Lecturer of Clinical Oncology
Medical Research Institute – Alexandria University
Guidelines to manage :
Aim: Updated International Guidelines
CIN
CIV
Highly emetogeni
c
Moderately emetogenic
Chemotherapy-induced Nausea
Chemotherapy-induced vomiting
I.V Chemotherapy regimens & drugs
ESMO
ASCO
NCCN
CIV Management
I.V Chemo.Oral Chemo.
Breakthrough emesis
Anticipatory emesis
Emesis prevention
TimingRisk
High VS Moderate VS Low Acute VS Delayed
I.V chemo + High risk for emesis
Options
NK 1 antagonist+
5-HT3 antagonist+
Dexamethasone
D1
Day2,3,4
NK 1 antagonist+
Dexamethasone
Netupitant/Palonosetron+
Dexamethasone
Dexamethasone
Olanzapine+
Palonosetron+
Dexamethasone
Olanzapine
I.V chemo + Moderate risk for emesis
Options
5-HT3 antagonist+
Dexamethasone+/-
NK 1 antagonist
D1
Day2,3
5-HT3 antagonistOR
DexamethasoneOR
NK 1 antagonist
Netupitant/Palonosetron+
Dexamethasone
-/+Dexamethasone
Olanzapine+
Palonosetron+
Dexamethasone
Olanzapine
European Society of Medical Oncology (ESMO) and the Multinational Association of Supportive
Care in Cancer (MASCC)2010
Summary:Combined anthracycline and cyclophosphamide (AC) regimens
were reclassified as highly emetic. AC is considered to be moderately emetic regimen in ESMO guidelines.
Patients who receive highly emetic agents should receive the three-drug combination of:
( 5-HT3 antagonist + dexamethasone + NK1 antagonist )NK1 receptor antagonist (days 1-3 for aprepitant - day 1 only for
fosaprepitant).
5- HT3 receptor antagonist (day 1 only).
Dexamethasone (days 1-3 or 1-4).
Same as
ESMO
&
NCCN
Moderately emetic regimens:Preferential use of palonosetron is recommended for
moderate emetic risk regimens, combined with dexamethasone.
The same as the ESMO guidelines for the Moderately emetic regimens
If palonosetron is not available, clinicians may substitute a first-generation 5-HT3 serotonin receptor antagonist, preferably granisetron or ondansetron.
Limited evidence also supports adding aprepitant to the combination.
For all other chemotherapies of moderate emetic risk, single agent dexamethasone or a 5-HT3 receptor antagonist is suggested for the prevention of emesis on days 2 and 3.