Supportive Care in Cancer

, Volume 28, Issue 2, pp 933–938 | Cite as

Chemotherapy-induced nausea and vomiting control in pediatric patients receiving ifosfamide plus etoposide: a prospective, observational study

  • Priya Patel
  • Sara R. Lavoratore
  • Jacqueline Flank
  • Meaghan Kemp
  • Ashlee Vennettilli
  • Helen Vol
  • Tracey Taylor
  • Elyse Zelunka
  • Anne Marie Maloney
  • Paul C. Nathan
  • L. Lee DupuisEmail author
Original Article



Little evidence exists regarding the emetogenicity of chemotherapy in pediatric patients. This study describes the prevalence of chemotherapy-induced nausea and vomiting (CINV) in pediatric patients receiving etoposide plus ifosfamide over 5 days, a common pediatric regimen.


English-speaking, non-chemotherapy-naïve patients aged 4 to 18 years about to receive etoposide 100 mg/m2/day plus ifosfamide 1800 mg/m2/day over 5 days participated. Antiemetic prophylaxis was determined by each patient’s care team. Emetic episodes were recorded and nausea severity was assessed by patients beginning with the first chemotherapy dose, continuing until 24 h after the last chemotherapy dose (acute phase) and ending 7 days later (delayed phase). The proportion of patients experiencing complete acute CINV control (no nausea, no vomiting, and no retching), the primary study endpoint, was described. The prevalence of complete chemotherapy-induced vomiting (CIV) and chemotherapy-induced nausea (CIN) during the acute, delayed, and overall (acute plus delayed) phases; complete delayed and overall CINV control; and anticipatory CINV were also determined.


Twenty-four patients participated; acute CINV was evaluable in 22. Most (75%; 18/24) received a 5-HT3 antagonist plus dexamethasone for antiemetic prophylaxis. Few (23%; 5/22) experienced complete acute CINV control. Complete acute CIV and CIN control were experienced by 57% (13/23) and 27% (6/22) of patients, respectively. Complete delayed CINV, CIV, and CIN control rates were 42% (8/19), 70% (14/20), and 42% (8/19), respectively.


Our findings support the classification of etoposide 100 mg/m2/day plus ifosfamide 1800 mg/m2/day IV over 5 days as highly emetogenic. This information will optimize antiemetic prophylaxis selection and CINV control in pediatric patients.


Chemotherapy-induced nausea and vomiting Emetogenicity Etoposide Ifosfamide Pediatrics 



We would like to thank the patients and families who generously agreed to participate in this study. We are also grateful to Ms. Sheliza Moledina, Mr. Calvin Liu, and Ms. Jocelyne Volpe for assistance during the study and to Ms. Nusheen Rostayee for administrative assistance.

Compliance with ethical standards

This prospective observational study was approved by the Research Ethics Board at The Hospital for Sick Children, Toronto, Canada. The patients or their parent provided informed consent for the study. The assent of patients who were unable to provide consent was obtained when appropriate.

Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Priya Patel
    • 1
    • 2
  • Sara R. Lavoratore
    • 3
  • Jacqueline Flank
    • 1
  • Meaghan Kemp
    • 1
  • Ashlee Vennettilli
    • 4
  • Helen Vol
    • 1
  • Tracey Taylor
    • 1
  • Elyse Zelunka
    • 1
  • Anne Marie Maloney
    • 5
  • Paul C. Nathan
    • 4
    • 6
    • 7
  • L. Lee Dupuis
    • 1
    • 2
    • 4
    Email author
  1. 1.Department of PharmacyThe Hospital for Sick ChildrenTorontoCanada
  2. 2.Leslie Dan Faculty of PharmacyUniversity of TorontoTorontoCanada
  3. 3.Rideau Community Health ServicesSmith FallsCanada
  4. 4.Child Health Evaluative Sciences, Research InstituteThe Hospital for Sick ChildrenTorontoCanada
  5. 5.Department of NursingThe Hospital for Sick ChildrenTorontoCanada
  6. 6.Department of PaediatricsThe Hospital for Sick ChildrenTorontoCanada
  7. 7.Institute of Health Policy, Management and EvaluationUniversity of TorontoTorontoCanada

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