Herrstedt, J., Roila, F., Warr, D., Celio, L., Navari, R., Hesketh, P., . . . Aapro, M.S. (2017). 2016 updated MASCC/ESMO consensus recommendations: Prevention of nausea and vomiting following high emetic risk chemotherapy. Supportive Care in Cancer, 25, 277–288.

DOI Link

Purpose & Patient Population

PURPOSE: To update the clinical guidelines for the prevention of chemotherapy-induced nausea and vomiting (CINV) with highly emetogenic chemotherapy (HEC)
 
TYPES OF PATIENTS ADDRESSED: Patients receiving HEC

Type of Resource/Evidence-Based Process

RESOURCE TYPE: Evidence-based guideline

PROCESS OF DEVELOPMENT: Literature review conducted after 2009 consensus conference. Mechanism of updated development not specifically described 
 
DATABASES USED: PubMed, Cochrane Collaboration  
 
INCLUSION CRITERIA: Antiemetic trials on patients receiving HEC; randomized, controlled trial (RCT)
 
EXCLUSION CRITERIA: Chemotherapy-radiotherapy, children, multiple-day chemotherapy, stem cell transplantation, refractory or breakthrough nausea and vomiting, underpowered

Phase of Care and Clinical Applications

PHASE OF CARE: Active antitumor treatment

Results Provided in the Reference

One thousand three hundred and thirty articles were initially retrieved, and a final set of 22 were used for the update.

Guidelines & Recommendations

Because of lack of FDA approval, evidence regarding casopitant was not included in guidelines. Because of FDA warning against IV dolasetron and ondansetron, these formulations are not recommended. Recommendations include:
  • Triple drug regimen for prevention of acute CINV—high level of evidence and consensus
  • Triple drug regimen with dexamethasone on days 2–4 for non-AC regimens—high level of evidence, moderate consensus
  • Triple drug regimen for the prevention of acute CINV with AC-based chemotherapy—high level of evidence and high consensus
  • Triple drug regimen with aprepitant or dexamethasone on days 2–3 if fosaprepitant, netupitant, or rolapitant was not used on day 1 to prevent delayed CINV with the AC regimen—moderate level of evidence and moderate consensus
  • Olanzapine and 5-HT3 and dexamethasone can be considered—low evidence and low consensus

Limitations

Very few studies examining olanzapine were included. More evidence is available.

Nursing Implications

This review provides guidelines regarding prophylaxis for acute and delayed CINV for patients receiving HEC or AC-based chemotherapy. Recommendations are consistent with those of other professional groups. This review does not include the consideration of dexamethasone-sparing regimens and does not include the full range of olanzapine-based regimen evidence.