2016 updated MASCC/ESMO consensus recommendations: prevention of nausea and vomiting following multiple-day chemotherapy, high-dose chemotherapy, and breakthrough nausea and vomiting
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This review summarizes the recommendations for the prophylaxis of acute and delayed nausea and vomiting induced by multiple-day chemotherapy, high-dose chemotherapy, and breakthrough nausea and vomiting as agreed at the MASCC/ESMO Antiemetic Guidelines update meeting in Copenhagen in June 2015.
A systematic literature search using PubMed from January 01, 2009 through January 06, 2015 with a restriction to papers in English was conducted.
There were three phase III randomized trials in patients undergoing high-dose chemotherapy and stem cell transplant and eight single arm non-randomized clinical studies (single in patients undergoing transplantation and one in patients receiving multiple-day chemotherapy treatment). We used a total of two randomized clinical trials in this guideline update. For patients receiving treatment for breakthrough chemotherapy-induced nausea and vomiting, a phase III randomized trial investigating the use of olanzapine versus metoclopramide in patients receiving highly emetogenic chemotherapy and a second single arm study looking at the effectiveness of olanzapine were identified.
It was concluded that for patients receiving high-dose chemotherapy with stem cell transplant, a combination of a 5-HT3 receptor antagonist with dexamethasone and aprepitant (125 mg orally on day 1 and 80 mg orally on days 2 to 4) is recommended before chemotherapy.
For patients undergoing multiple-day chemotherapy-induced nausea and vomiting, a 5-HT3 receptor antagonist, dexamethasone, and aprepitant, are recommended before chemotherapy for the prophylaxis of acute emesis and delayed emesis.
For patients experiencing breakthrough nausea and vomiting, the available evidence suggests the use of 10 mg oral olanzapine, daily for 3 days. Mild to moderate sedation in this patient population (especially elderly patients) is a potential problem with this agent.
KeywordsCINV Multiple-day chemotherapy High-dose chemotherapy Breakthrough nauseas and vomiting NK1 receptor antagonists 5-HT3 receptor antagonists
Compliance with ethical standards
Conflict of interest
Lawrence H. Einhorn
Amgen: Stock Options
Biogenidec: Stock Options
Bernardo L. Rapoport
Merck and Co: Receipt of grants/research supports, receipt of honoraria or consultation fees and participation in a company sponsored speaker’s bureau
Tesaro Inc.: Receipt of grants/research supports, receipt of honoraria or consultation fees and participation in a company sponsored speaker’s bureau
Herron Therapeutics: Receipt of honoraria or consultation fees
Rudolph M. Navari
The author declares that he has no competing interests.
Tesaro Inc.: Consultant Tesaro and remuneration SOBI
Mary J. Brames
The author declares that she has no competing interests.
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