Jordan, K., Roila, F., Molassiotis, A., Maranzano, E., Clark-Snow, R. A., Feyer, P., & MASCC/ESMO. (2011). Antiemetics in children receiving chemotherapy. MASCC/ESMO guideline update 2009. Supportive Care in Cancer, 19(Suppl 1), 37-42.doi:10.1007/s00520-010-0994-7
To provide a consensus statement derived from published articles as well as expert opinion about antiemetic therapy in children younger than 18 years
This resource is a guideline, developed by the Multinational Association of Supportive Care in Cancer (MASCC) and European Society of Medical Oncology (ESMO).
A panel of 23 oncology professionals determined the level of evidence and confidence according to EMSO and MASCC criteria. Between 2004 and June 2009, eight articles were published regarding 5-HT3 receptor antagonists (RAs) in pediatric populations (two regarding safety issues, four dose-finding or -optimizing studies, and two comparative studies), four articles reported on the NK1 RA aprepitant (one randomized study, two case reports, and one study on the liquid formulation of aprepitant), and two miscellaneous studies looked at the impact of an antiemetic pump and the value of metopimazine when added to ondansetron. Recommendations were classified using the MASCC level of scientific confidence and consensus.
Pertinent information from the published literature from 2004 to June 2009 was retrieved and reviewed for the creation of this guideline.
Database searched was Medline.
Search keywords were antiemetics, chemotherapy-induced emesis, children, neoplasms, nausea, vomiting, serotonin antagonists, neurokinin 1 receptor antagonists, phenothiazines, butyrophenones, cannabinoids, corticosteroids, and metoclopramide.
No inclusion criteria were identified.
Articles were excluded if they were review articles or addressed emesis not caused by chemotherapy.
Children receiving chemotherapy should receive a 5-HT3 RA and dexamethasone for antiemetic prophylaxis both in highly emetogenic and moderately emetogenic chemotherapy. A significant lack of well-designed randomized studies exist to evaluate the problem of chemotherapy-induced emesis in children. Optimal dosing in children and management of delayed and anticipatory CINV in children is not yet clear. Investigation is needed regarding the potential role of NK1 RAs and the 5-HT3 RAs palonosetron and transdermal granisetron for future consideration in pediatrics.