abstract: Management of highly emetogenic chemotherapy

Management of highly emetogenic chemotherapy. [Curr Opin Oncol. 2012] - PubMed - NCBI

 Definition for emetogenic:

Web definitions:

Vomiting (known medically as emesis and informally as throwing up and a number of other terms) is the forceful expulsion of the contents... en.wikipedia.org/wiki/Emetogenic

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Abstract

PURPOSE OF REVIEW:

This review updates the clinical data on antiemetic therapy for chemotherapy classified as highly emetogenic.

RECENT FINDINGS:

A meta-analysis demonstrated that palonosetron was superior to other 5-hydroxytryptamine3 (5-HT3) receptor antagonists at least in the absence of aprepitant. Two major guideline groups have reclassified all chemotherapy that contains cyclophosphamide and an anthracycline as 'highly emetogenic'. Although recommended prophylaxis for drugs in that category includes aprepitant, phase II studies with cyclophosphamide, doxorubicin, vincristine and prednisone (CHOP) and doxorubicin, bleomycin, vincristine and dacarbazine (ABVD) demonstrated that single agent palonosetron alone provided control of emesis over 85% of patients. A randomized phase III trial of olanzapine versus aprepitant found that the control of emesis was similar and nausea was significantly better controlled with olanzapine. Two studies showed that there is no impact of the moderate cytochrome P450 3A4 (CYP3A4) inhibitor aprepitant on the pharmacokinetics of cyclophosphamide. Surveys in the United States and Europe demonstrated that antiemetic prescribing practices often do not adhere to guidelines even for highly emetogenic chemotherapy.

SUMMARY:

The major guideline groups recommend a combination of a 5-HT3 receptor antagonist, dexamethasone and aprepitant ('triple therapy') for treatment categorized as highly emetogenic. Recent data suggest that, although classified as highly emetogenic, palonosetron may provide very good control of emesis for CHOP and ABVD.
Guidelines have not made firm recommendations for highly emetogenic chemotherapy administered over several days or stem cell transplant preparative regimens due to the lack of published randomized trials. Although well tolerated and effective, many patients receive suboptimal antiemetic therapy that includes aprepitant.

2011 National Guideline Clearinghouse | Antiemetics (nausea): American Society of Clinical Oncology clinical practice guideline update.

Guideline Title:

Antiemetics: American Society of Clinical Oncology clinical practice guideline update.

also note: 

FDA Warning/Regulatory Alert

Note from the National Guideline Clearinghouse: This guideline references a drug(s) for which important revised regulatory and/or warning information has been released.

• September 15, 2011 – Zofran (ondansetron) : The U.S. Food and Drug Administration (FDA) notified healthcare professionals and patients of an ongoing safety review and labeling changes for the anti-nausea drug Zofran (ondansetron, ondansetron hydrochloride and generics). Ondansetron may increase the risk of developing prolongation of the QT interval of the electrocardiogram, which can lead to an abnormal and potentially fatal heart rhythm, including Torsade de Pointes.

Podcast:and transcript: Managing nausea and vomiting during chemotherapy - MayoClinic (includes discussion on anticipatory/delayed nausea/vomiting)

Podcast: Managing nausea and vomiting during chemotherapy - MayoClinic.com

Future Oncology -- Summary: Palonosetron for the prevention of chemotherapy-induced nausea and vomiting in patients with cancer

Drug Evaluation
Palonosetron for the prevention of chemotherapy-induced nausea and vomiting in patients with cancer
Rudolph M Navari‌1,2


Chemotherapy-induced nausea and vomiting (CINV) is associated with a significant deterioration in quality of life. The emetogenicity of the chemotherapeutic agents, repeated chemotherapy cycles and patient characteristics (e.g., female gender, younger age, low alcohol consumption and history of motion sickness) are the major risk factors for CINV. This article provides a detailed description of palonosetron, a second-generation 5-hydroxytryptamine-3 (5-HT3) receptor antagonist, which has been approved for the prevention of acute CINV in patients receiving either moderately or highly emetogenic chemotherapy and for the prevention of delayed CINV in patients receiving moderately emetogenic chemotherapy...... palonosetron in combination with dexamethasone demonstrated better control of delayed CINV in patients receiving highly emetogenic chemotherapy and had a similar safety profile. Owing to its efficacy in controlling both acute and delayed CINV, palonosetron may be very effective in the clinical setting of multiple-day chemotherapy and bone marrow transplantation.