Table 2.
2023 updated MASCC-ESMO recommendations high emetic risk chemotherapy
| Question | Recommendation | Note | Level of evidence | Grade of recommendation |
|---|---|---|---|---|
| How to prevent acute nausea and vomiting following non-AC chemotherapy of high emetic risk (HEC)? | A four-drug regimen including single doses of a 5-HT3 receptor antagonist, dexamethasone (DEX), an NK1 receptor antagonist (aprepitant, fosaprepitant, netupitant*, fosnetupitant* or rolapitant), and olanzapine given before chemotherapy is recommended | *Netupitant/fosnetupitant is administered with palonosetron as part of the fixed-dose combination agent NEPA | I | A |
| How to prevent delayed nausea and vomiting following non-AC HEC? | In patients receiving non-AC HEC treated with a combination of a 5-HT3 receptor antagonist, DEX*, an NK1 receptor antagonist**, and olanzapine to prevent acute nausea and vomiting, DEX and olanzapine on days 2 to 4 is suggested to prevent delayed nausea and vomiting (see note about DEX dosing) |
* A few studies have investigated a 1-day DEX regimen as an option in cisplatin with one study demonstrating comparable efficacy between a 1-day and multi-day DEX schedules ** If aprepitant 125 mg is used on day 1, then aprepitant 80 mg × 1 should be administered on days 2–3 |
II | B |
| How to prevent acute nausea and vomiting following anthracycline-cyclophosphamide (AC)-based chemotherapy of high emetic risk? | In women treated with AC-based chemotherapy, a four-drug regimen including single doses of a 5-HT3 receptor antagonist, DEX, an NK1 receptor antagonist (aprepitant, fosaprepitant, netupitant*, fosnetupitant* or rolapitant), and olanzapine given before chemotherapy is recommended |
This recommendation is based on extensive data in women treated with adjuvant AC for breast cancer *Netupitant/fosnetupitant is administered with palonosetron as part of the fixed-dose combination agent NEPA |
I | A |
| How to prevent delayed nausea and vomiting following anthracycline-cyclophosphamide (AC)-based chemotherapy of high emetic risk? | In women treated with a combination of a 5-HT3 receptor antagonist, DEX, an NK1 receptor antagonist*, and olanzapine to prevent acute nausea and vomiting, olanzapine on days 2 to 4 is suggested to prevent delayed nausea and vomiting |
This recommendation is based on extensive data in women treated with adjuvant AC for breast cancer *If aprepitant 125 mg is used on day 1, then aprepitant 80 mg × 1 should be administered on days 2–3 |
II | B |
| Which dose and schedule of olanzapine is to be preferred in the prevention of acute and delayed nausea and vomiting following chemotherapy of high emetic risk? | The best investigated dose is 10 mg. 5 mg is superior to placebo, but it is unknown if it is as effective as 10 mg, because no robust studies have compared the 5 mg and 10 mg doses. The only schedule investigated is once daily for 4 days (see note about sedation) | If sedation is a concern, a starting daily dose of 5 mg and/or administration at bedtime is an option | II | B |