Antiemetics: ASCO Guideline Update
- Study type
- Clinical guideline
- Study name
- ASCO Antiemetics 2020
- Design
- Clinical practice guideline based on a systematic review of randomised controlled trials and their meta-analyses, developed by an ASCO expert panel
- Sample size
- Systematic review including 3 publications from the updated search and 10 publications on immune checkpoint inhibitors (CPIs)
- Source
- JCO · 2020
In plain words
This guideline explains how nausea and vomiting caused by cancer treatments can be prevented. When immunotherapy (CPI) is given together with chemotherapy, dexamethasone should still be one of the anti-sickness medicines. If immunotherapy is given on its own or as a combination of two immunotherapy drugs, a routine preventive anti-sickness medicine is usually not needed. Your treating doctor decides on the type and dose of the medicines.
Key points
Key guideline recommendations
Recommendations for adults are unchanged, except for the option of adding olanzapine in the haematopoietic stem cell transplant setting.
Dosing information now includes the option of a 5 mg dose of olanzapine in adults and intravenous formulations of aprepitant and netupitant-palonosetron.
The option of fosaprepitant has been added to the paediatric recommendations.
There is no clinical evidence to justify omitting dexamethasone from guideline-consistent prophylactic antiemetic regimens when CPIs are given with chemotherapy to adults.
CPIs given alone or in combination with another CPI do not require routine prophylactic antiemetics.
Study population
Adults and children receiving anticancer treatment who need prevention of treatment-induced nausea and vomiting. The question on dexamethasone and CPIs was examined using randomised trials of adding a CPI to chemotherapy; two phase 3 trials in adults with non-small-cell lung cancer had compared platinum-based doublet chemotherapy with or without the PD-1 inhibitor pembrolizumab.
Endpoints
This document is a clinical practice guideline and has no specific primary or secondary endpoint. Its aim was to update the guideline to include new anticancer agents, antiemetics and antiemetic regimens, and to give a recommendation on the use of dexamethasone as a prophylactic antiemetic in patients receiving immune checkpoint inhibitors (CPIs).
Safety and side effects
The abstract gives no information on adverse events (grade ≥3).
Clinical significance and place in guidelines
With this update, the adult recommendations remained largely unchanged. Dexamethasone should not be omitted from guideline-consistent prophylactic antiemetic regimens when a CPI is given with chemotherapy. Single-agent CPIs or a combination of two CPIs do not need routine prophylactic antiemetics. Olanzapine may be added in the haematopoietic stem cell transplant setting. A 5 mg dose of olanzapine and intravenous formulations of aprepitant and netupitant-palonosetron are listed as options, and fosaprepitant has been added to the paediatric recommendations. The current status of the guideline and newer versions should be checked.
Limitations
The abstract does not state the level of evidence or strength of the recommendations; the full guideline must be consulted for these. Evidence on dexamethasone and CPIs comes from trials that assessed adding a CPI to chemotherapy; the abstract names two phase 3 trials in non-small-cell lung cancer. Errata have been published for this paper and should be checked when using the full text.
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.