Annals of Oncology 2009 20(Supplement 4):iv156-iv158; doi:10.1093/annonc/mdp160
© The Author 2009. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved. For permissions, please email: journals.permissions@oxfordjournals.org
ESMO clinical recommendations |
Chemotherapy-induced nausea and vomiting: ESMO Clinical Recommendations for prophylaxis
J. Herrstedt1,
F. Roila2 and
On behalf of the ESMO Guidelines Working Group*
1 Department of Oncology, Odense University Hospital, Odense, Denmark
2 Department of Medical Oncology, S. Maria Hospital, Terni, Italy
* Correspondence to: ESMO Guidelines Working Group, ESMO Head office, Via L. Taddei 4, CH-6962 Viganello-Lugano, Switzerland; E-mail: clinicalrecommendations{at}esmo.org
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other causes of nausea and vomiting to be considered in cancer patients
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Radiotherapy, radiosensitizers, infection, metabolic disorders,
electrolyte disturbances, constipation, gastrointestinal obstruction,
cachexia syndrome, metastases (brain, liver, bone), paraneoplasia,
other emetogenic medication (e.g. opioids, antibiotics, antifungals,
amifostine) and psychological.
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antiemetics
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5-Hydroxytryptamine type 3 receptor (5HT
3) (serotonin) antagonists,
corticosteroids and aprepitant are usually given once daily.
However, for delayed emesis corticosteroids are given twice
daily Dopamine antagonists are given three or four times daily.
For routine use oral doses are recommended [I, A]. Palonosetron
is only available as an i.v. formulation. Substances of the
same class are of comparable efficacy [I, A].
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antiemetic administration
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Antiemetics are given prophylactically 30–60 min before
the start of chemotherapy. If a patient has nausea and vomiting,
treatment should be given intravenously. Recommendations concern
chemotherapy-naive patients. The oral agents are those with
the lowest emetic risk. A single antiemetic is often sufficient
as prophylaxis. The oral agents rarely induce delayed nausea
and vomiting and no routine prophylaxis after day 1 is recommended.
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note
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Levels of evidence [I–V] and grades of recommendation
[A–D] as used by the American Society of Clinical Oncology
are given in square brackets. Statements without grading were
considered justified standard clinical practice by the expert
authors and the ESMO faculty.
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footnotes
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Approved by the ESMO Guidelines Working Group: April 2002, last
update September 2008. This publication supercedes the previously
published version—Ann Oncol 2008; 19 (Suppl 2): ii110–ii112.
Conflict of interest: Professor Herrstedt has reported that he performs ad hoc advisory board activity for Merck, GSK, Helsinn, Schering-Plough and Amgen; he is currently conducting research sponsored by Merck; Dr Roila has reported that he is a member of the advisory board on Palonosetron for Helsinn Healthcare, on Aprepitant for Merck, Sharp & Dohme; he is conducting research sponsored by GSK and Merck, Sharp & Dohme on casopitant and fosaprepitant; he has been a speaker at a Satellite Symposium organized by Merck, Helsinn and Italfarmaco.
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references
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1. The Antiemetic Subcommittee of the Multinational Association of Supportive Care in Cancer. Prevention of chemotherapy- and radiotherapy-induced emesis: results of the 2004 Perugia International Antiemetic Consensus Conference. Ann Oncol (2006) 17:20–28.
[Abstract/Free Full Text]2. Antiemetic resource center at www.mascc.org.
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