ASCO GUIDELINES Bundle

Antiemetics (CINV)

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4 Treatment Multiday Antineoplastic Therapy ➤ Adult patients treated with multiday antineoplastic agents should be offered antiemetics before treatment that are appropriate for the emetic risk of the antineoplastic agent given on each day of the antineoplastic treatment and for 2 days after completion of the antineoplastic regimen (Moderate Recommendation; EB-I). ➤ Adult patients treated with 4- or 5-day cisplatin regimens should be offered a three-drug combination of an NK 1 receptor antagonist, a 5-HT 3 receptor antagonist, and dexamethasone (Strong Recommendation; EB-H). Breakthrough Nausea and Vomiting ➤ For patients with breakthrough nausea or vomiting, clinicians should re-evaluate emetic risk, disease status, concurrent illnesses, and medications; and ascertain that the best regimen is being administered for the emetic risk (Moderate Recommendation; IC-L). ➤ Adult patients who experience nausea or vomiting despite optimal prophylaxis, and who did not receive olanzapine prophylactically, should be offered olanzapine in addition to continuing the standard antiemetic regimen (Moderate Recommendation; EB-I). ➤ Adult patients who experience nausea or vomiting despite optimal prophylaxis, and who have already received olanzapine, may be offered a drug of a different class (eg, an NK 1 receptor antagonist, lorazepam or alprazolam, a dopamine receptor antagonist, dronabinol, or nabilone) in addition to continuing the standard antiemetic regimen (Moderate Recommendation; IC-I for dronabinol and nabilone, L otherwise). Anticipatory Nausea and Vomiting ➤ All patients should receive the most active antiemetic regimen appropriate for the antineoplastic agents being administered. Clinicians should use such regimens with initial antineoplastic treatment, rather than assessing the patient's emetic response with less effective antiemetic treatment. If a patient experiences anticipatory emesis, clinicians may offer behavioral therapy with systematic desensitization (Moderate Recommendation; IC-L).

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