2023 updated MASCC/ESMO consensus recommendations: prevention of nausea and vomiting following high-emetic-risk antineoplastic agents
- Study type
- Clinical guideline
- Study name
- MASCC/ESMO 2023 HEC
- Design
- Systematic review following PRISMA guidance and consensus recommendations (update of the 2016-2017 recommendations)
- Sample size
- 46 new relevant references (randomised trials, systematic reviews and meta-analyses; literature search from 1 January 2015 to 1 February 2023)
- Source
- Support Care Cancer · 2023
In plain words
Some chemotherapy drugs, such as cisplatin and the combination of cyclophosphamide with an anthracycline in breast cancer, carry a high chance of nausea and vomiting. This guideline shows that to prevent these side effects, doctors usually prescribe a combination of four medicines, with olanzapine as a fixed part of it. How long dexamethasone (a steroid) is taken depends on the type of chemotherapy: with the AC combination the first day alone is enough, while for other high-risk drugs 4 days are recommended. Always make the final decision about the medicines and their doses with your treating doctor.
Key points
Key guideline recommendations
- Level of evidence in the full text of the paper
After AC-type highly emetogenic chemotherapy (anthracycline + cyclophosphamide), a steroid (dexamethasone) is not needed after day 1.
- Level of evidence in the full text of the paper
For non-AC highly emetogenic chemotherapy, a 4-day dexamethasone regimen is recommended.
- Level of evidence in the full text of the paper
Olanzapine is now recommended as a fixed component of the four-drug antiemetic prophylaxis regimen in both non-AC HEC and AC-type HEC.
- Level of evidence in the full text of the paper
No major differences were identified between 5-HT3 receptor antagonists or between NK1 receptor antagonists; no new antiemetic qualified for inclusion in the updated recommendations.
Study population
This guideline concerns patients receiving highly emetogenic chemotherapy (HEC). According to the abstract, HEC still includes cisplatin, carmustine, dacarbazine, mechlorethamine, streptozocin, cyclophosphamide at doses above 1500 mg/m² and the combination of cyclophosphamide with an anthracycline (AC) in women with breast cancer.
Endpoints
Main topics reviewed: (1) steroid-sparing or steroid-free regimens, (2) olanzapine-containing regimens, and (3) other topics including comparisons of antiemetics within the same class, intravenous NK1 receptor antagonists and potential new antiemetics.
Safety and side effects
The abstract does not report adverse event data (grade ≥3); safety details are available in the full text of the paper.
Clinical significance and place in guidelines
This update recommends a four-drug antiemetic prophylaxis regimen including olanzapine for both non-AC HEC and AC, and limits dexamethasone after AC-HEC to day 1, whereas a 4-day regimen is recommended for non-AC HEC. According to the abstract, no major differences were found between 5-HT3 antagonists or between NK1 antagonists. Doses and practical details should be confirmed from the full text of the guideline and institutional protocols.
Limitations
The abstract does not mention the limitations of the review. The search was limited to randomised trials, systematic reviews and meta-analyses published up to February 2023. The abstract does not provide the full list of five recommendations, the levels of evidence or the strength of recommendations; the full text must be consulted for these. According to the conflict-of-interest disclosures, some authors received honoraria or consulting fees from pharmaceutical companies.
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.