Key Hospitalist Clinical Practice Guidelines in 2017

Antiemetics in Adults and Children

American Society of Clinical Oncology

Adult patients

High-emetic-risk antineoplastic agents

• Adult patients who are treated with cisplatin and other high-emetic-risk single agents should be offered a 4-drug combination of a neurokinin 1 (NK₁) receptor antagonist, a serotonin (5-HT₃) receptor antagonist, dexamethasone, and olanzapine. Dexamethasone and olanzapine should be continued on days 2-4.

• Adult patients who are treated with an anthracycline combined with cyclophosphamide should be offered a 4-drug combination of an NK₁ receptor antagonist, a 5-HT₃ receptor antagonist, dexamethasone, and olanzapine. Olanzapine should be continued on days 2-4.

Moderate-emetic-risk antineoplastic agents

• Adult patients who are treated with carboplatin area under the curve (AUC) ≥4 mg/mL per minute should be offered a 3-drug combination of an NK₁ receptor antagonist, a 5-HT₃ receptor antagonist, and dexamethasone.

• Adult patients who are treated with moderate-emetic-risk antineoplastic agents, excluding carboplatin AUC ≥4 mg/mL per minute, should be offered a 2-drug combination of a 5-HT₃ receptor antagonist (day 1) and dexamethasone (day 1).

• Adult patients who are treated with cyclophosphamide, doxorubicin, oxaliplatin, and other moderate-emetic-risk antineoplastic agents that are known to cause delayed nausea and vomiting may be offered dexamethasone on days 2-3.

Breakthrough nausea and vomiting

• Adult patients who experience nausea or vomiting despite optimal prophylaxis, and who did not receive olanzapine prophylactically, should be offered olanzapine in addition to continuing the standard antiemetic regimen.

• Adult patients who experience nausea or vomiting despite optimal prophylaxis, and who have already received olanzapine, may be offered a drug of a different class—for example, an NK₁ receptor antagonist, lorazepam or alprazolam, a dopamine receptor antagonist, dronabinol, or nabilone—in addition to continuing the standard antiemetic regimen.

High-emetic-risk radiation therapy

• Adult patients who are treated with high-emetic-risk radiation therapy should be offered a 2-drug combination of a 5-HT₃ receptor antagonist and dexamethasone before each fraction and on the day after each fraction if radiation therapy is not planned for that day.

Concurrent radiation and antineoplastic agent therapy

• Adult patients who are treated with concurrent radiation and antineoplastic agents should receive antiemetic therapy that is appropriate for the emetic risk level of antineoplastic agents, unless the risk level of the radiation therapy is higher. During periods when prophylactic antiemetic therapy for antineoplastic agents has ended and ongoing radiation therapy would normally be managed with its own prophylactic therapy, patients should receive prophylactic therapy that is appropriate for the emetic risk of the radiation therapy until the next period of antineoplastic therapy, rather than receiving rescue therapy for antineoplastic agents as needed.

Pediatric Patients

High-emetic-risk antineoplastic agents

• Pediatric patients who are treated with high-emetic-risk antineoplastic agents should be offered a 3-drug combination of a 5-HT₃ receptor antagonist, dexamethasone, and aprepitant.

• Pediatric patients who are treated with high-emetic-risk antineoplastic agents who are unable to receive aprepitant should be offered a 2-drug combination of a 5-HT₃ receptor antagonist and dexamethasone.

• Pediatric patients who are treated with high-emetic-risk antineoplastic agents who are unable to receive dexamethasone should be offered a 2-drug combination of palonosetron and aprepitant.

References

• Hesketh PJ, Kris MG, Basch E, et al. Antiemetics: American Society of Clinical Oncology Clinical Practice Guideline Update. J Clin Oncol. 2017 Jul 31. http://ascopubs.org/doi/full/10.1200/JCO.2017.74.4789

• Mulcahy N. New Antiemetic Guidelines Issued by ASCO. Medscape News & Perspective. Oncology. WebMD Inc. July 31, 2017. http://www.medscape.com/viewarticle/883608

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Any views expressed above are the author's own and do not necessarily reflect the views of WebMD or Medscape.

Cite this: John Anello, Brian Feinberg, John Heinegg, et. al. Key Hospitalist Clinical Practice Guidelines in 2017 - Medscape - Jan 16, 2018.