Roila, F., Warr, D., Aapro, M., Clark-Snow, R.A., Einhorn, L., Gralla, R. J., … Tonato, M. (2011). Delayed emesis: Moderately emetogenic chemotherapy (single-day chemotherapy regimens only). Supportive Care in Cancer, 19(Suppl 1), S57–S62.

To update the recommendations for the prophylaxis of delayed emesis induced by moderately emetogenic chemotherapy via a systematic review

The database searched was PubMed.

Search keywords were moderately, chemotherapy emesis, casopitant, aprepitant, granisetron, ondansetron, dolasetron, tropisetron, palonosetron antagonists, and dopamine receptor antagonists

Studies were included in the review if they 

• Were randomized, controlled trials (RCTs).
• Described subjects receiving moderately emetogenic chemotherapy (MEC) as defined by the Multinational Association of Supportive Care in Cancer (MASCC).

Papers were excluded if they were not in English.

The number of references retrieved was not provided. The method of study evaluation was the presence of vomiting.

• The final number of studies included in the review was nine RCTs.
• The total sample size was 4,177; however, not all numbers were included. The study sample sizes ranged from 99–1,114 participants.
• All patients were receiving MEC.

• Patients were undergoing the active treatment phase of care.
• The study has clinical applicability for late effects and survivorship.

• This study of aprepitant and casopitant demonstrated that, when added to a 5-HT₃ receptor antagonist and dexamethasone, a neurokinin 1 (NK1) receptor antagonist reduces the incidence of acute and delayed emesis induced by anthracycline- and cyclophosphamide-based chemotherapy.
• For patients receiving MEC, one dose of palonosetron administered before chemotherapy was more efficacious in reducing the incidence of delayed emesis than a single dose of a 5 -HT₃ receptor antagonist with a shorter half-life.
• Weak evidence suggested that a dopamine receptor antagonist may improve the control of delayed emesis.

• Patients receiving MEC, which is known to be associated with significant incidence of delayed nausea and vomiting, should receive antiemetic prohylaxis for delayed emesis.
• In patients with breast cancer receiving a combination of anthracycline plus cyclophosphamide treated with a combination of aprepitant, a 5-HT₃ receptor antagonist, and dexamethasone to prevent acute nausea and vomiting, aprepitant should be used to prevent delayed nausea and vomiting.
• Multiday oral dexamethasone is the preferred treatment for the prevention of delayed emesis in patients receiving chemotherapy with moderate emetic risk. 
• Insurance concerns continue with 5-HT₃ as well as NK1 receptor agonsists.  Nurses need to consider this when assisting patients with nausea, and they should consider the need for precertification or prior authorization of medications.