article · ESMO Open
An international multidisciplinary expert panel updated clinical guidelines for preventing nausea and vomiting caused by chemotherapy and radiotherapy, reviewing evidence published between June 2015 and January 2023. Key recommendations include using olanzapine within preventative regimens for patients receiving highly emetogenic chemotherapy, as well as for treating breakthrough symptoms. A simplified one-day dexamethasone schedule is advised for patients receiving moderately emetogenic treatments, including carboplatin and anthracycline-cyclophosphamide combinations. For women aged 50 and younger undergoing oxaliplatin therapy, the guidance suggests adding a neurokinin-1 receptor antagonist. In radiation settings, the guidelines recommend aprepitant or fosaprepitant weekly for women receiving fractionated radiotherapy with concurrent weekly cisplatin. The updated guidance also introduces suggestions regarding selected integrative and non-pharmacological supportive therapies.
Nausea and vomiting are distressing side effects that can severely disrupt cancer treatment and patient quality of life. By updating evidence-based protocols with refined drug regimens and supportive interventions, these recommendations help clinical teams standardise care, reduce adverse reactions, and improve treatment adherence for oncology patients undergoing intensive chemotherapy or radiotherapy.
These updated clinical guidelines provide actionable protocols for hospital oncology units, clinical pharmacists, and health service providers. Because the recommendations focus on established pharmaceutical agents such as olanzapine, dexamethasone, and neurokinin-1 receptor antagonists alongside non-pharmacological methods, they are immediately applicable in clinical practice. However, the abstract does not indicate a commercialisation pathway or direct product development opportunities.
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The 2015 MASCC–ESMO guideline for the prevention of ChT- and RINV was updated based on a literature search from 1 June 2015 through 31 January 2023. Thirty-four multidisciplinary experts reviewed the literature. The most important updates were as follows:1)Recommendation to use olanzapine as part of the prophylaxis for patients receiving HEC;2)Recommendation of a 1-day DEX schedule in patients treated with AC, carboplatin or other MEC;3)Suggestion to include an NK1-RA in the antiemetic regimen for women aged ≤50 years receiving oxaliplatin;4)Suggestion to use olanzapine for breakthrough CINV;5)For the first time providing suggestions for the use of some integrative and non-pharmacological therapies; and6)Recommending aprepitant or fosaprepitant as part of the weekly antiemetic regimen in women treated with fractionated radiotherapy and concomitant weekly cisplatin.
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DOI: 10.1016/j.esmoop.2023.102195
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