Garcia Gomez, J., Perez Lopez, M. E., Garcia Mata, J., Isla Casado, D., & SEOM (Spanish Society for Medical Oncology). (2010). SEOM clinical guidelines for the treatment of antiemetic prophylaxis in cancer patients receiving chemotherapy. Clinical & Translational Oncology, 12, 770-774.

To update the 2005 Spanish Society of Medical Oncology (SEOM) clinical guidelines for the treatment of chemotherapy-induced emesis and to continue to improve the supportive care of patients with cancer

The Clinical Guideline Working Group, on behalf of the Spanish Society of Medical Oncology (SEOM) Executive Committee, provided expert opinion based on a review of the literature covering patients with cancer receiving chemotherapy.

All patients were in active treatment. This paper has application to antiemetic drugs.

• For highly emetogenic chemotherapy, one-day regimen, the following is recommended.
  • Day 1:  5-HT₃ receptor antagonist (preferably palonosetron); 125 mg oral aprepitant; and 12 mg IV or oral dexamethasone
  • Days 2-3: 80 mg oral aprepitant per day
  • Days 2-4: 4 mg oral dexamethasone every 12 hours
• For moderately emetogenic chemotherapy, one-day regimen, the following is recommended.
  • Day 1:  5-HT₃ receptor antagonist and 8 mg IV or oral dexamethasone
  • Days 2-3: 4 mg oral dexamethasone every 12 hours
• For low-emetogenic chemotherapy, the recommendation is day 1, 12 mg IV or oral dexamethasone or, alternatively, 0.5 mg/kg IV or oral metochlopromide.
• For minimally emetogenic chemotherapy, no prophylactic antiemetics are recommended.
• For multiple-day chemotherapy, the recommendation is day 1, 5-HT₃ receptor antagonist (palonosetron) and dexamethasone.
• For delayed emesis, dexamethasone is recommended.
• For refractory emesis and rescue treatment, metoclopromide, benzodiazepines, and/or phenothiazines, butyrophenones, or olanzapine are recommended.
• For acute and delayed emesis, three recommendations are made.
  • Palonosetron, a second-generation serotonin receptor antagonist, has been shown to be at least equally effective as first-generation antagonists when controlling acute emesis and more effective than first-generation antagonists when controlling delayed emesis.
  • Aprepitant, a neurokinin 1 receptor antagonist, with serotonin receptor antagonists and steroids are recommended.
  • Combining dexamethasone with other antiemetics is more effective at controlling chemotherapy-induced nausea and vomiting (CINV) than using dexamethasone alone. 
• For anticipatory nausea and emesis, use benzodiazepines, such as lorazepam.
• The authors cautioned that the use of metoclopramide as an antiemetic is limited by the presence of serious side effects such as akathisia, extrapyramidal reactions, and dose dependency.
   

Prevention of CINV can be accomplished through pharmacologic interventions, increasing patients' quality of life. The use of 5-HT₃, along with dexamethasone and aprepitant, seems to be the most effective regimen. Although these recommendations are helpful, no insight into cost implications and little discussion of potential side effects of antiemetic treatment were provided. Additionally, the recommendations offered are purely pharmacologic and, thus, only aimed at those with prescriptive authority.