Einhorn, L., Rapoport, B., Navari, R., Herrstedt, J., Brames, M., Einhorn, L.H., . . . Brames, M.J. (2017). 2016 updated MASCC/ESMO consensus recommendations: Prevention of nausea and vomiting following multiple-day chemotherapy, high-dose chemotherapy, and breakthrough nausea and vomiting. Supportive Care in Cancer, 25, 303–308.

DOI Link

Purpose & Patient Population

PURPOSE: To update the recommendations published after the last MASCC/ESMO conference in 2009

TYPES OF PATIENTS ADDRESSED: Adults undergoing multi-day or high-dose chemotherapy and those with breakthrough nausea and vomiting

Type of Resource/Evidence-Based Process

RESOURCE TYPE: Consensus-based guideline

PROCESS OF DEVELOPMENT: A literature search for papers published between January 1, 2009, and January 6, 2015, related to high-dose chemotherapy, multiple-day chemotherapy regimens, and breakthrough nausea and vomiting

DATABASES USED: PubMed

INCLUSION CRITERIA: Clinical trials, systematic reviews, stem cell transplantations (SCTs), patients with germ cell tumors

EXCLUSION CRITERIA: Other studies

Phase of Care and Clinical Applications

PHASE OF CARE: Active antitumor treatment

Results Provided in the Reference

For high-dose chemotherapy, 111 references were found, then filtered to include only clinical trials. Forty of these were identified to include, and out of these, 12 clinical trials were used. For multiple-day chemotherapy, the search was limited to patients with germ cell tumors receiving multiday cisplantin regimens. Three studies were used. For breakthrough nausea and vomiting, seven references were found, but when filtered to only clinical trials, three references were identified.

Guidelines & Recommendations

High-dose chemotherapy and SCT: Add aprepitant to a 5-HT₃ and dexamethasone regimen.

For multiple-day cisplatin: An antiemetic regimen of a 5-HT₃ antagonist, dexamethasone, and aprepitant for acute phase and dexamethasone for the delayed phase. Aprepitant can also be used in both the acute and delayed phases on days 3–7 of a five-day chemotherapy regimen.

For breakthrough nausea and vomiting: Prophylactic antiemetics should be used to prevent chemotherapy-induced nausea and vomiting (CINV). Use olanzapine 10 mg daily for three days for breakthrough CINV.

Limitations

Few studies related to the prevention of acute and delayed CINV in patients receiving high-dose and multiple-day chemotherapy regimens and for breakthrough nausea and vomiting. Little evidence related to the control of nausea exists.

Nursing Implications

Aprepitant should be added to two-drug antiemetic regimens in patients receiving high-dose and multiple-day cisplatin regimens to prevent acute and delayed CINV. Olanzapine is recommended for breakthrough CINV.