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2016 updated MASCC/ESMO consensus recommendations: Prevention of acute chemotherapy-induced nausea and vomiting in children

Abstract

Purpose

To update the 2009 recommendations for the prevention of acute chemotherapy-induced emesis in children.

Methods

We updated the original systematic literature search. Randomized studies were included in the evidence to support this guideline if they were primary studies fully published in full text in English or French; included only children less than 18 years old or, for mixed studies of adults and children, reported the pediatric results separately or the median or mean age was no more than 13 years; evaluated acute chemotherapy-induced nausea and vomiting (CINV) prophylaxis; provided sufficient information to permit determination of the emetogenicity of the antineoplastic therapy administered or the study investigators stated the emetogenicity of the chemotherapy administered; included an implicit or explicit definition of complete acute CINV response; described the antiemetic regimen in full; and reported the complete acute CINV response rate as a proportion.

Results

Twenty-five randomized studies, including eight published since 2009, met the criteria for inclusion in this systematic review. Prophylaxis with a 5-HT3 antagonist (granisetron or ondansetron or palonosetron or tropisetron) ± dexamethasone ± aprepitant is recommended for children receiving highly or moderately emetogenic chemotherapy. For children receiving chemotherapy of low emetogenicity, a 5-HT3 antagonist is recommended.

Conclusions

The findings of several randomized trials were used to update recommendations for the prevention of acute CINV. However, significant research gaps remain and must be addressed before CINV control in children can be optimized.

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Acknowledgments

The MASCC Pediatric Guideline Development Panel is grateful to the Pediatric Oncology Group of Ontario (POGO) for granting permission to edit and update the evidence tables prepared for the 2013 POGO Guideline for the Prevention of Acute Nausea and Vomiting Due to Antineoplastic Medication in Pediatric Cancer Patients. The guidance of Dr. P.D. Robinson with respect to clinical practice guideline methods is acknowledged with thanks. The assistance of Ms. Elizabeth Uleryk, Library Scientist, with the literature search is also gratefully acknowledged as is the assistance of Dr. Priya Patel and Ms. Mila Khanna.

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Correspondence to L. Lee Dupuis.

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Conflict of interest

L.L. Dupuis has participated in research partially supported by Sea-Band Ltd. A. Molassiotis has received honoraria and support from MSD Merck, Helsinn, Tesaro, Norgine, and Acacia Pharma. A. Orsey holds stock in Pfizer. Other authors had no disclosures to declare.

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Dupuis, L.L., Sung, L., Molassiotis, A. et al. 2016 updated MASCC/ESMO consensus recommendations: Prevention of acute chemotherapy-induced nausea and vomiting in children. Support Care Cancer 25, 323–331 (2017). https://doi.org/10.1007/s00520-016-3384-y

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Keywords

  • Pediatrics
  • Antiemetics
  • Chemotherapy-induced vomiting
  • Chemotherapy-induced nausea
  • Supportive care