Antiemetics: American Society of Clinical Oncology Clinical Practice Guideline Update
A newer version of this guideline has been published: Antiemetics: ASCO Guideline Update (2020)
- Study type
- Clinical guideline
- Study name
- ASCO Antiemetics 2017
- Design
- Clinical practice guideline update based on a systematic review of the medical literature (November 2009 to June 2016) by an ASCO expert panel
- Sample size
- 41 publications included in the systematic review
- Source
- JCO · 2017
In plain words
This guideline gives updated advice on preventing and treating nausea and vomiting caused by chemotherapy and radiotherapy. It says that for many patients it is better to use the most effective combination of anti-sickness medicines from the very start, rather than first trying weaker medicines to see how the body reacts. The choice of medicines depends on the type of chemotherapy or radiotherapy and should be agreed with the treating doctor.
Key points
Key guideline recommendations
Olanzapine should be added to antiemetic regimens for adults who receive highly emetogenic antineoplastic agents or who have breakthrough nausea and vomiting.
For adults who receive anthracycline and cyclophosphamide chemotherapy, dexamethasone should be given on day 1 only.
A neurokinin 1 receptor antagonist should be added for adults who receive carboplatin AUC ≥ 4 mg/mL per minute or high-dose chemotherapy, and for paediatric patients who receive highly emetogenic antineoplastic agents.
For radiation-induced nausea and vomiting, the anatomic regions, risk levels and antiemetic dosing schedules were revised; for radiotherapy with low emetic risk, rescue therapy only is recommended.
The most effective antiemetic regimens appropriate for the antineoplastic agent or radiotherapy should be used from the start of treatment, rather than first assessing the patient's emetic response with less effective treatment.
Study population
Adults and children treated with anticancer agents (chemotherapy and other antineoplastic agents) and patients undergoing radiotherapy who are at risk of treatment-induced nausea and vomiting.
Endpoints
This guideline is an update of the recommendations for the prevention and treatment of chemotherapy- and radiotherapy-induced nausea and vomiting. Details of the endpoints of the included studies are not given in the abstract and appear in the full text.
Safety and side effects
The abstract gives no detailed information on adverse events; see the full guideline for drug safety details.
Clinical significance and place in guidelines
This update added olanzapine to antiemetic regimens for highly emetogenic agents and for breakthrough nausea and vomiting, expanded the role of NK1 receptor antagonists (carboplatin AUC ≥ 4, high-dose chemotherapy and high-risk children) and limited dexamethasone to day 1 in anthracycline plus cyclophosphamide regimens. For low-risk radiotherapy, rescue therapy only is recommended. This guideline was published in 2017; the current status of the recommendations and later updates should be checked.
Limitations
The abstract does not address the guideline's limitations or the level of evidence and strength of each recommendation; these should be checked in the full text. The systematic review covers only publications from November 2009 to June 2016.
This summary was prepared by the editorial team from the published paper; the original paper is the final reference. Read the original abstract on PubMed.