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2023 updated MASCC/ESMO Consensus recommendations: Prevention of nausea and vomiting following moderately emetic risk antineoplastic agents

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Abstract

Purpose

Review the literature to update the MASCC guidelines from 2015 for controlling nausea and vomiting with systemic cancer treatment of moderate emetic potential.

Methods

A systematic literature review was completed using Medline, Embase, and Scopus databases. The literature search was done from June 2015 to January 2023 of the management of antiemetic prophylaxis for anticancer therapy of moderate emetic potential.

Results

Of 342 papers identified, 19 were relevant to update recommendations about managing antiemetic prophylaxis for systemic cancer treatment regimens of moderate emetic potential. Important practice changing updates include the use of emetic prophylaxis based on a triple combination of neurokinin (NK)1 receptor antagonist, 5-HT3 receptor antagonist, and steroids for patients undergoing carboplatin (AUC ≥ 5) and women < 50 years of age receiving oxaliplatin-based treatment. A double combination of 5-HT3 receptor antagonist and steroids remains the recommended prophylaxis for other MEC. Based on the data in the literature, it is recommended that the administration of steroids should be limited to day 1 in moderately emetogenic chemotherapy regimens, due to the demonstration of non-inferiority between the different regimens.

More data is needed on the emetogenicity of new agents at moderate emetogenic risk. Of particular interest would be antiemetic studies with the agents sacituzumab-govitecan and trastuzumab-deruxtecan. Experience to date with these agents indicate an emetogenic potential comparable to carboplatin > AUC 5. Future studies should systematically include patient-related risk assessment in order to define the risk of emesis with MEC beyond the emetogenicity of the chemotherapy and improve the guidelines for new drugs.

Conclusion

This antiemetic MASCC-ESMO guideline update includes new recommendations considering individual risk factors and the optimization of supportive anti-emetic treatments.

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Change history

  • 12 February 2024

    The correct family name should be: Iihara

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Author information

Authors and Affiliations

  1. Interdisciplinary Patient Pathway Division, Gustave Roussy, 114 Rue Edouard Vaillant, 94800, Villejuif, France

    Florian Scotté

  2. Reno College of Medicine, University of Nevada, Reno, NV, USA

    Lee Schwartzberg

  3. Department of Pharmacy, Gifu University Hospital, Gifu, Japan

    Hirotoshi Iihara

  4. Genolier Cancer Center, Genolier, Switzerland

    Matti Aapro

  5. Albert Einstein College of Medicine, Jacobi Medical Center, Bronx, NY, USA

    Richard Gralla

  6. Division of Hematology Oncology, Lahey Hospital and Medical Center, Burlington, MA, USA

    Paul J. Hesketh

  7. Department of Hematology, Oncology and Palliative Medicine, Ernst Von Bergmann Hospital, Potsdam, Germany

    Karin Jordan

  8. Department of Medicine V, Hematology, Oncology and Rheumatology, University of Heidelberg, Heidelberg, Germany

    Karin Jordan

  9. Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada

    Ronald Chow

  10. Department of Clinical Oncology, Zealand University Hospital, Roskilde, Denmark

    Jørn Herrstedt

  11. University of Copenhagen, Copenhagen, Denmark

    Jørn Herrstedt

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  1. Florian Scotté
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Contributions

FS and LS did the literature search. All authors reviewed the selected publications. The initial draft was written by FS, and all authors revised it critically for its intellectual content.

All authors reached agreement on the recommendations, are accountable for the accuracy and integrity of the work, and have approved the final version of the manuscript.

Corresponding author

Correspondence to Florian Scotté.

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Conflict of interest

Florian Scotté declares he has received honoraria from Sanofi, Sandoz, Roche, MSD, Prostrakan, Leo Pharma, Janssen, AMGEN, Pierre Fabre Oncologie, Vifor Pharma, Arrow, Pfizer, BMS, Bayer, Thermo Fisher, Pharmanovia, Gilead, Viatris, and Helsinn.

Lee Schwartzberg declares he has received honoraria from Helsinn, GlaxoSmithKline, and Pfizer.

Hirotoshi Iihara declares that he has received personal fees from Taiho, Chugai, Yakult, Astellas, Eli Lilly, Daiichi Sankyo, AstraZeneca, Nippon Kayaku, Ono, and Nippon Boehringer Ingelheim and consulting fees for their institution from Taiho and Eisai outside the submitted work.

Matti Aapro declares the following interests relevant to this manuscript: has received honoraria from Berlin-Chemie, Fosun, Helsinn Healthcare SA, Juniper Biologics, Knight Therapeutics, Mundipharma International Limited, and Vifor Pharma.

Richard Gralla declares the following interests relevant to this manuscript: has received honoraria from Fosun, Helsinn Healthcare SA, Juniper Biologics, Knight Therapeutics, Mundipharma International Limited, and Vifor Pharma.

Paul J Hesketh declares that he has no financial interests.

Karin Jordan reports personal fees as an invited speaker from Amgen, Art Tempi, Helsinn Healthcare SA, Hexal, Med Update GmbH, MSD, Mundipharma, Onkowissen, Esteve, Roche, Shire (Takeda), and Vifor; personal fees for advisory board membership from Amgen, AstraZeneca, BD Solutions, Hexal, Karyopharm, and Voluntis; and personal fees as author for UpToDate.

Ronald Chow declares that he has no financial interests.

Jørn Herrstedt declares he has received honoraria from Pharmathen S.A.

The other authors have no relevant financial or non-financial interests to declare.

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Scotté, F., Schwartzberg, L., Iihara, H. et al. 2023 updated MASCC/ESMO Consensus recommendations: Prevention of nausea and vomiting following moderately emetic risk antineoplastic agents. Support Care Cancer 32, 45 (2024). https://doi.org/10.1007/s00520-023-08222-3

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