Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Feb 12;33(3):181.
doi: 10.1007/s00520-025-09211-4.

MASCC antiemetic consensus recommendations: resource-limited settings

Snezana M Bosnjak  1 , Ana Zilic  2 , Venkatraman Radhakrishnan  3 , Vikas Ostwal  4 , Matti Aapro  5 , Hirotoshi Iihara  6 , Teresa Smit  7 , Richard Gralla  8
Affiliations

MASCC antiemetic consensus recommendations: resource-limited settings

Snezana M Bosnjak et al. Support Care Cancer. .

Abstract

Purpose: Prevention of chemotherapy-induced nausea and vomiting (CINV) remains an essential supportive care need for patients receiving cancer treatment. Due to inadequate access to antiemetics in many countries, guideline-recommended CINV prophylaxis is not always possible. Our goal was to formulate antiemetic recommendations for resource-limited settings and define alternative antiemetic regimens for the CINV prophylaxis after highly (HEC) and moderately emetic chemotherapy (MEC), when NK1-receptor antagonists are not accessible.

Methods: The recommendations based on the MASCC/ESMO 2023 Guideline Update were considered as the best option. The stratification based on a meta-analysis published by Filetti et al. (2023) was used in order to select and rank NK1-receptor antagonist-free regimens by their probability of achieving complete response. Alternative NK1-receptor antagonist-free regimens based on olanzapine are proposed, ranked by their efficacy as "better" and "good" options when "best" regimens recommended by the MASCC/ESMO 2023 Guideline Update were not available or affordable.

Results: For the prevention of acute CINV, in patients receiving HEC (HEC-cisplatin and AC-HEC) with no access to an NK1-receptor antagonist, a 3-drug regimen including single doses of a 5-HT3-receptor antagonist, dexamethasone, and olanzapine given before chemotherapy is recommended as an alternative option. Olanzapine and dexamethasone are recommended days 2-4 after chemotherapy. The O10PD regimen (10 mg olanzapine, palonosetron, and dexamethasone) is suggested as the alternative regimen in the category "better." Other 5-HT3-receptor antagonists (ondansetron, granisetron) may be used if palonosetron is not affordable (category "good"). No guideline is possible for the alternative regimens to prevent acute CINV following MEC because of limited (carboplatin, AUC ≥ 5) or unavailable data (oxaliplatin chemotherapy in women aged < 50 years). Limited data are also available on the management of CINV following trastuzumab-deruxtecan.

Conclusion: The most effective prevention of CINV recommended by the MASCC/ESMO 2023 Guideline Update must be given when available and affordable. These recommendations were developed to facilitate decision on which regimen to use when the best MASCC/ESMO 2023 recommended regimen is not accessible because NK1-receptor antagonists are either not available or not affordable.

Keywords: Antiemetics; Guideline; HEC; High-emetic risk chemotherapy; MEC; Moderately emetic risk chemotherapy; Olanzapine.

PubMed Disclaimer

Conflict of interest statement

Declarations. Competing interests: SB has received personal fees as an invited speaker from ADOC, Amicus, BMS, Hemofarm, La Roche Posay and PharmaSwiss; she reports non-financial interests as President of the Serbian Association for Supportive Care in Cancer, member of the Central Eastern Europe Regional Council of ASCO, as well as a member of the Palliative and Supportive Care Faculty of ESMO and ESCO. AZ has received fees as invited speaker from Sandoz and travel expenses support from PharmaSwiss and Salveo. VO has received travel/accommodation expenses as an invited speaker from AstraZeneca, Merck and as an advisory board member for Lupin and Natco; he reports institutional financial interests as an advisory board member for AstraZeneca, Natco, Panaceo, Reddy's Lab and Zydus Cadila; institutional drug support from Alkem, Eisai, Intas and Micro Labs; institutional funding from Reddy's Lab and Zydus Cadila; he reports non-financial interests for leadership roles in Every Nation Mumbai India and the Indian Association of Supportive Care in Cancer. MA has received personal fees as an invited speaker from Amgen and ViforPharma; personal fees as an advisory board member for Astellas; personal financial interests as a member of the Board of Directors of the International Society of Geriatric Oncology (SIOG) and Union for International Cancer Control (UICC); grants to Sharing Progress in Cancer Care (SPCC) from AstraZeneca, BMS, Daiichi Sankyo, ExactSciences, Fresenius Kabi, Helsinn, Mundipharma, Novartis, Pfizer and Roche; institutional financial interests as a member of the Board of Directors of All. Can International and SPCC; he reports non-financial interests for advisory roles to various companies subject to confidentiality agreements, membership of the American Society of Clinical Oncology (ASCO), MASCC and Sociedade Brasileira de Oncologia Clínica (SBOC), leadership roles at SIOG and SPCC, and a member of the Scientific Advisory Board of the European School of Oncology (ESO). HI received personal fees from Astellas, AstraZeneca, Chugai, Daiichi Sankyo, Eisai, Eli Lilly, Nippon Boehringer Ingelheim, Nippon Kayaku, Ohara, Sawai, Taiho and Yakult, and consulting fees for their institution from Taiho and Eisai, as well as personal fees from Daiichi Sankyo, Astellas, and Taiho. All other authors have declared no conflicts of interest.

Similar articles

See all similar articles

References

    1. Herrstedt J, Clark-Snow R, Ruhlmann CH, Molassiotis A, Olver I, Rapoport BL, Aapro M, Dennis K, Hesketh PJ, Navari RM, Schwartzberg L, Affronti ML, Garcia-Del-Barrio MA, Chan A, Celio L, Chow R, Fleury M, Gralla RJ, Giusti R, Jahn F, Iihara H, Maranzano E, Radhakrishnan V, Saito M, Sayegh P, Bosnjak S, Zhang L, Lee J, Ostwal V, Smit T, Zilic A, Jordan K, Scotté F, participants of the MASCC/ESMO Consensus Conference 2022 (2023) MASCC and ESMO guideline update for the prevention of chemotherapy- and radiotherapy-induced nausea and vomiting. ESMO Open 9:102195. https://doi.org/10.1016/j.esmoop.2023.102195 - DOI
    1. Cufer T, Kosty MP (2023) ESMO/ASCO recommendations for a global curriculum in medical oncology edition 2023. ESMO Open 8:101631. https://doi.org/10.1016/j.esmoop.2023.101631 - DOI - PubMed - PMC
    1. Antiemetic Subcommittee of the Multinational Association of Supportive Care in Cancer (MASCC) (1998) Prevention of chemotherapy- and radiotherapy-induced emesis: results of Perugia Consensus Conference. Ann Oncol 9:811–819 - DOI
    1. Gralla RJ, Osoba D, Kris MG, Kirkbride P, Hasketh PJ, Chinnery LW et al (1999) Recommendations for the use of antiemetics: evidence-based, clinical practice guidelines. J Clin Oncol 17:2971–2994. https://doi.org/10.1200/JCO.1999.17.9.2971 - DOI - PubMed
    1. Hesketh PJ, Kris MG, Basch E, Bohlke K, Barbour SY, Clark-Snow RA, Danso MA, Dennis K, Dupuis LL, Dusetzina SB, Eng C, Feyer PC, Jordan K, Noonan K, Sparacio D, Lyman GH (2020) Antiemetics: ASCO guideline update. J Clin Oncol 38:2782–2797. https://doi.org/10.1200/JCO.20.01296 - DOI - PubMed

MeSH terms

LinkOut - more resources