Guidelines for CINV Prophylaxis and Treatment

The three clinical guidelines for chemotherapy-induced nausea and vomiting (CINV) prophylaxis, which are published by the Multinational Association of Supportive Care in Cancer/European Society for Medical Oncology (MASCC/ESMO), NCCN, and ASCO—are fairly similar to one another, says Eric Roeland, MD. One area of debate is whether to add an NK1 antagonist early on for those who have an increased likelihood of experiencing CINV. Patient risk factors include female gender, those who abstain from alcohol, history of motion sickness, or history of sickness during pregnancy.

The ASCO guideline recommends an NK1 receptor antagonist, a 5HT3 receptor antagonist, and dexamethasone for patients who are being treated with a highly emetogenic chemotherapy, states Charles L. Loprinzi, MD. For moderately emetogenic chemotherapy, the guideline recommends palonosetron plus dexamethasone.

The MASCC/ESMO guideline, published in 2013, is similar to ASCO. However, it considers Adriamycin (doxorubicin)/cyclophosphamide to be a moderately emetogenic chemotherapy regimen. By contrast, says Loprinzi, ASCO upgraded this agent to a highly emetogenic therapy.

The NCCN guideline, updated in 2015, includes newer drugs, such as netupitant, that were unavailable at the time the other two guidelines were published. NCCN also includes olanzapine, notes Loprinzi.