Radiation Oncology/Supportive care/Nausea

Supportive Care for Nausea and Vomiting

Ematogenicity Potential

 * ASCO 2020 PMID 28759346 --Antiemetics: American Society of Clinical Oncology Clinical Practice Guideline Update (Hesketh PJ, J Clin Oncol. 2017 Oct 1;35(28):3240-3261. doi: 10.1200/JCO.2017.74.4789. Epub 2017 Jul 31.)
 * Classification of chemotherapy regimens
 * Classification of radiation therapy regimens:
 * High Risk: Total Body Irradiation => Odansetron / Granisetron + Dexamethasone
 * Moderate Risk: Upper abdomen, Craniospinal => Odansetron / Granisetron / Topisetron + Dexamethasone
 * Low Risk: Brain, H&N, Thorax, Pelvis => Odansetron/Granisetron PRN, Dexamethasone PRN, Prochlorperazine / Metoclopramide PRN


 * ASCO; 1997 PMID 8996130 -- "Proposal for classifying the acute emetogenicity of cancer chemotherapy." (Hesketh PJ, J Clin Oncol. 1997 Jan;15(1):103-9.)
 * Review of clinical trials. Chemotherapy agents divided into 5 levels

5-HT3 antagonists

 * Ondansetron (Zofran)
 * Granisetron (Kytril)
 * Dolasetron (Anzemet)
 * Palonosetron (Aloxi) - IV, 0.25 mg


 * Umea; 1996 (Sweden) PMID 8879372 -- "A randomised placebo controlled study with ondansetron in patients undergoing fractionated radiotherapy." (Franzen L, Ann Oncol. 1996 Aug;7(6):587-92.)
 * Randomized. 111 patients, abdominal RT, at least 10 fractions. Used [EORTC C30] questionnaire
 * Outcome: complete control of emesis ondansetron 67% vs. placebo 45% (SS). Number of emetic episodes on worst day 1.4 vs. 3.1 (SS), also fewer days with emesis for ondansetron. Benefit during week 1-3, not after
 * Conclusion: Prophylactic ondansetron effective in preventing N/V in abdominal RT

NK-1 antagonists

 * Aprepitant (Emend) - PO


 * Aprepitant Protocol 052
 * 2003 PMID 14559886 -- "The oral neurokinin-1 antagonist aprepitant for the prevention of chemotherapy-induced nausea and vomiting: a multinational, randomized, double-blind, placebo-controlled trial in patients receiving high-dose cisplatin--the Aprepitant Protocol 052 Study Group." (Hesketh PJ, J Clin Oncol. 2003 Nov 15;21(22):4112-9. Epub 2003 Oct 14.)
 * Randomized. 530 patients, receiving cisplatin >=70 mg/m2 for first time. Arm 1) standard therapy (ondansetron + dexamethasone) vs. Arm 2) aprepitant + standard therapy. N/V episodes recorded in diary. CR defined as no emesis on days 1-5
 * Outcome: CR standard 52% vs. aprepitant + standard 73% (SS)
 * Conclusion: Addition of aprepitant provided superior protection against chemotherapy-induced nausea and vomiting