2023 updated MASCC/ESMO Consensus recommendations: Prevention of nausea and vomiting following moderately emetic risk antineoplastic agents
- Study type
- Clinical guideline
- Study name
- MASCC/ESMO 2023 MEC
- Design
- Consensus guideline based on a systematic literature review (search of Medline, Embase and Scopus from June 2015 to January 2023)
- Sample size
- 342 papers identified, of which 19 were relevant
- Source
- Support Care Cancer · 2023
In plain words
Some chemotherapy drugs carry a moderate risk of causing nausea and vomiting. This guideline helps doctors choose better preventive medicines. For some patients, such as those receiving high-dose carboplatin or women under 50 receiving oxaliplatin, a three-drug combination is recommended. For most other patients, a two-drug combination is enough, and the steroid is needed only on the first day of chemotherapy. Any change to your medicines should be agreed with your doctor.
Key points
Key guideline recommendations
- Level of evidence not stated in the abstract; see the full text
For patients treated with carboplatin (AUC ≥ 5) and women under 50 years receiving oxaliplatin-based therapy, antiemetic prophylaxis with the triple combination of a neurokinin (NK)1 receptor antagonist, a 5-HT3 receptor antagonist and a steroid is recommended.
- Level of evidence not stated in the abstract; see the full text
The two-drug combination of a 5-HT3 receptor antagonist and a steroid remains the recommended prophylaxis for other MEC regimens.
- Level of evidence not stated in the abstract; see the full text
It is recommended that steroid administration in moderately emetogenic chemotherapy regimens be limited to day 1, because non-inferiority between different regimens has been shown.
Study population
Patients receiving systemic cancer therapy with moderately emetogenic agents (MEC). Further details of the target population are not given in the abstract and are in the full text of the paper.
Endpoints
This paper is a guideline and has no trial endpoint. Its aim was to update the 2015 MASCC guideline for the control of nausea and vomiting caused by moderately emetogenic systemic cancer therapy.
Safety and side effects
The abstract gives no information on grade ≥ 3 adverse events.
Clinical significance and place in guidelines
According to this guideline, for patients receiving carboplatin (AUC ≥ 5) and women under 50 years treated with oxaliplatin-based therapy, three-drug prophylaxis with an NK1 antagonist, a 5-HT3 antagonist and a steroid is recommended. For other MEC, the two-drug combination of a 5-HT3 antagonist and a steroid is still recommended, and the steroid should be limited to day 1. Experience so far suggests that sacituzumab govitecan and trastuzumab deruxtecan have an emetogenic potential comparable to carboplatin > AUC 5, but more antiemetic data are needed for these drugs. The status of adoption of this guideline in other national or organisational guidelines should be checked separately.
Limitations
According to the abstract, more data are needed on the emetogenic potential of new moderately emetogenic drugs, especially sacituzumab govitecan and trastuzumab deruxtecan. Future studies should also systematically include patient-related risk assessment so that emetic risk is defined beyond the emetogenic potential of the chemotherapy itself.
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.