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. 2023 Dec 21;32(1):47.
doi: 10.1007/s00520-023-08221-4.

2023 updated MASCC/ESMO consensus recommendations: prevention of nausea and vomiting following high-emetic-risk antineoplastic agents

Jørn Herrstedt  1   2 , L Celio  3 , P J Hesketh  4 , L Zhang  5 , R Navari  6 , A Chan  7 , M Saito  8 , R Chow  9 , M Aapro  10
Affiliations

2023 updated MASCC/ESMO consensus recommendations: prevention of nausea and vomiting following high-emetic-risk antineoplastic agents

Jørn Herrstedt et al. Support Care Cancer. .

Abstract

Purpose: This systematic review updates the MASCC/ESMO recommendations for high-emetic-risk chemotherapy (HEC) published in 2016-2017. HEC still includes cisplatin, carmustine, dacarbazine, mechlorethamine, streptozocin, and cyclophosphamide in doses of > 1500 mg/m2 and the combination of cyclophosphamide and an anthracycline (AC) in women with breast cancer.

Methods: A systematic review report following the PRISMA guidelines of the literature from January 1, 2015, until February 1, 2023, was performed. PubMed (Ovid), Scopus (Google), and the Cochrane Database of Systematic Reviews were searched. The literature search was limited to randomized controlled trials, systematic reviews, and meta-analyses.

Results: Forty-six new references were determined to be relevant. The main topics identified were (1) steroid-sparing regimens, (2) olanzapine-containing regimens, and (3) other issues such as comparisons of antiemetics of the same drug class, intravenous NK1 receptor antagonists, and potentially new antiemetics. Five updated recommendations are presented.

Conclusion: There is no need to prescribe steroids (dexamethasone) beyond day 1 after AC HEC, whereas a 4-day regimen is recommended in non-AC HEC. Olanzapine is now recommended as a fixed part of a four-drug prophylactic antiemetic regimen in both non-AC and AC HEC. No major differences between 5-HT3 receptor antagonists or between NK1 receptor antagonists were identified. No new antiemetic agents qualified for inclusion in the updated recommendations.

Keywords: Antiemetics; Guideline; HEC; High-emetic-risk chemotherapy; Nausea; Vomiting.

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Conflict of interest statement

Jørn Herrstedt (JH) declares that he has received honoraria from PharmaThen S.A.

Luigi Celio (LC) has received consulting fees Italfarmaco; speaker’s fee Berlin-Chemie AG.

Paul J Hesketh (PJH) declares that he has no financial interests.

Li Zhang (LZ) declares that he has no financial interests.

Rudolph M Navari (RMN) declares that he has no financial interests.

Alexandre Chan (AC) declares that he has no financial interests.

Mitsue Saito (MS) declares that she has no financial interests.

Ronald Chow (RC) declares that he has no financial interests.

Matti Aapro (MA) declares the following interests relevant to this manuscript: has received honoraria from Berlin-Chemie, Fosun, Helsinn Healthcare SA, Juniper Biologics, Knight Therapeutics, Mundipharma International Limited, Vifor Pharma.

Figures

Fig. 1
Fig. 1
Flowchart literature search: HEC and antiemetics
See this image and copyright information in PMC

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