Roila, F., Molassiotis, A., Herrstedt, J., Aapro, M., Gralla, R.J., Bruera, E., . . . participants of the MASCC/ESMO Consensus Conference Copenhagen 2015. (2016). 2016 MASCC and ESMO guideline update for the prevention of chemotherapy- and radiotherapy-induced nausea and vomiting and of nausea and vomiting in advanced cancer patients. Annals of Oncology, 27(Suppl. 5), v119–v133. 

PURPOSE: To update antiemetic guidelines published by ESMO and MASCC in 2009

 

TYPES OF PATIENTS ADDRESSED: Adult and pediatric patients receiving chemotherapy and/or radiotherapy

PROCESS OF DEVELOPMENT: To change a guideline from the 2010 recommendation; a consensus of at least 67% of the expert panelists was needed. The panel considered changes of 10% or greater to be sufficient to warrant the change of a recommendation.

 

DATABASES USED: Not described in this publication; referenced the 2010 publication to describe the process; this process involved using MEDLINE with evaluation by 23 oncology professionals from various disciplines.

 

INCLUSION CRITERIA: Articles that described new agents identified from January 2009–June 2015

 

EXCLUSION CRITERIA: If the new agent was an oral agent, the study had to measure emetic risk for the entire course of therapy, not just for a single dose.

PHASE OF CARE: Active antitumor treatment

 

APPLICATIONS: Pediatrics

Forty-two new antineoplastic agents and 168 studies were identified since the 2010 guideline was updated. The emetogenicity of agents was also reviewed and updated as appropriate. 

 

Low Emetic Agents

IV: Aflibercept, belinostat, blinatumomab, brentuximab, cabazitasel, carfilzomib, eribulin, ipilimumab, nab-paclitaxel, pegylated liposomal doxorubicin, pertuzumab, trastuzumab-emtansine, vinflunine  

Oral: Afatinib, axatinib, dabrafenib, dastinib, ibrutinib, idelalisib, nilotinib, olaparib, pazopanib, ponatinib, regorafenib, vandetabin, and vorinostat

 

Moderate Emetic Agents

IV: Temozolomide, trabectedin, romidepsin, thiotepa

Oral: Bosutinib, crizotinib and ceritinib

 

Minimally Emetic Agents

IV: Nivolumab, ofatumumab, pembrolizumab, and pixantrone

Oral: Pomalidomide, ruxolitinib, vermurafenib, and vismodegib

A major update of the guideline was the inclusion of oral antineoplastic agents. Two new NK₁ receptor antagnists—netupitant and rolapitant—were discussed for their role in acute and delayed chemotherapy-induced nausea and vomiting (CINV) induced by cisplatin, AC chemotherapy, or carboplatin in combination with a 5-HT₃ plus dexamethasone. Two studies suggested that aprepitant and metoclopramide were equally effective in the prophylaxis of cisplatin-induced delayed nausea and vomiting, and that dexamethasone was as effective as aprepitant in women with breast cancer receiving an AC combination. A new classification of the emetogenic potential of radiotherapy according to irradiated sites was reported, as well as an update of recommended antiemetic treatments. Last, adding an NK₁ receptor antagonist to a 5-HT₃ receptor antagonist plus dexamethasone was addressed in multiple-day cisplatin-based chemotherapy and high-dose chemotherapy. If an NK₁ receptor antagonist is not available for the prophylaxis of AC-induced CINV, palonsetron is the preferred 5-HT₃ receptor antagonist.

Randomized clinical trials have not yet compared the new NK₁s and NK₁ receptor antagonist combinations. Oral medications have not yet been studied extensively, so they are not included in the guidelines. The authors recognized that nausea continues to be a problem, even with marked improvement in vomiting, and believe there should be a shift to the control of nausea. A review of the process requires readers to go back to the 2010 and 2004 publications.