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).
