ASCO GUIDELINES Bundle

Antiemetics (CINV)

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5 High Emetic Risk Radiation Therapy ➤ Adult patients treated with high-emetic-risk radiation therapy should be offered a two-drug combination of a 5-HT 3 receptor antagonist and dexamethasone before each fraction and on the day after each fraction, if radiation therapy is not planned for that day (Strong Recommendation; EB-H). Moderate Emetic Risk Radiation Therapy ➤ Adult patients treated with moderate-emetic-risk radiation therapy should be offered a 5-HT 3 receptor antagonist before each fraction, with or without dexamethasone before the first five fractions (Moderate Recommendation; EB-H). Low Emetic Risk Radiation Therapy ➤ Adult patients treated with radiation therapy to the brain should be offered rescue dexamethasone therapy. Patients who are treated with radiation therapy to the head and neck, thorax, or pelvis should be offered rescue therapy with a 5-HT 3 receptor antagonist, dexamethasone, or a dopamine receptor antagonist (Weak Recommendation; IC-L). Minimal Emetic Risk Radiation Therapy ➤ Adult patients treated with minimal emetic risk radiation therapy should be offered rescue therapy with a 5-HT 3 receptor antagonist, dexamethasone, or a dopamine receptor antagonist (Weak Recommendation; IC-L). Concurrent Radiation and Antineoplastic Agent Therapy ➤ Adult patients treated with concurrent radiation and antineoplastic agents should receive antiemetic therapy appropriate for the emetic risk level of the antineoplastic agents, unless the risk level of the radiation therapy is higher. During periods when prophylactic antiemetic therapy for the antineoplastic agents has ended, and ongoing radiation therapy would normally be managed with its own prophylactic therapy, patients should receive prophylactic therapy appropriate for the emetic risk of the radiation therapy until the next period of antineoplastic therapy, rather than receiving rescue therapy for the antineoplastic agents as needed (Moderate Recommendation; IC-I).

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