domingo, 15 de enero de 2012

National Guideline Clearinghouse | Antiemetics: American Society of Clinical Oncology clinical practice guideline update.

full-text:
National Guideline Clearinghouse Antiemetics: American Society of Clinical Oncology clinical practice guideline update.

Guideline Title

Antiemetics: American Society of Clinical Oncology clinical practice guideline update.

Bibliographic Source(s)

Basch E, Prestrud AA, Hesketh PJ, Kris MG, Feyer PC, Somerfield MR, Chesney M, Clark-Snow RA, Flaherty AM, Freundlich B, Morrow G, Rao KV, Schwartz RN, Lyman GH. Antiemetics: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol 2011 Nov 1;29(31):4189-98. [56 references] PubMed

Guideline Status

This is the current release of the guideline.

This guideline updates a previous version: Kris MG, Hesketh PJ, Somerfield MR, Feyer P, Clark-Snow R, Koeller JM, Morrow GR, Chinnery LW, Chesney MJ, Gralla RJ, Grunberg SM. American Society of Clinical Oncology guideline for antiemetics in oncology: update 2006. J Clin Oncol 2006 Jun 20;24(18):1-16. [110 references]

J Clin Oncol. 2011 Nov 1;29(31):4189-98. Epub 2011 Sep 26.

Antiemetics: American Society of Clinical Oncology clinical practice guideline update.

Basch E, Prestrud AA, Hesketh PJ, Kris MG, Feyer PC, Somerfield MR, Chesney M, Clark-Snow RA, Flaherty AM, Freundlich B, Morrow G, Rao KV, Schwartz RN, Lyman GH; American Society of Clinical Oncology.

Source

Memorial Sloan-Kettering Cancer Center, New York, USA.

Abstract

PURPOSE:

To update the American Society of Clinical Oncology (ASCO) guideline for antiemetics in oncology.

METHODS:

A systematic review of the medical literature was completed to inform this update. MEDLINE, the Cochrane Collaboration Library, and meeting materials from ASCO and the Multinational Association for Supportive Care in Cancer were all searched. Primary outcomes of interest were complete response and rates of any vomiting or nausea.

RESULTS:

Thirty-seven trials met prespecified inclusion and exclusion criteria for this systematic review. Two systematic reviews from the Cochrane Collaboration were identified; one surveyed the pediatric literature. The other compared the relative efficacy of the 5-hydroxytryptamine-3 (5-HT(3)) receptor antagonists.

RECOMMENDATIONS:

Combined anthracycline and cyclophosphamide regimens were reclassified as highly emetic. Patients who receive this combination or any highly emetic agents should receive a 5-HT(3) receptor antagonist, dexamethasone, and a neurokinin 1 (NK(1)) receptor antagonist. A large trial validated the equivalency of fosaprepitant, a single-day intravenous formulation, with aprepitant; either therapy is appropriate. Preferential use of palonosetron is recommended for moderate emetic risk regimens, combined with dexamethasone. For low-risk agents, patients can be offered dexamethasone before the first dose of chemotherapy. Patients undergoing high emetic risk radiation therapy should receive a 5-HT(3) receptor antagonist before each fraction and for 24 hours after treatment and may receive a 5-day course of dexamethasone during fractions 1 to 5. The Update Committee noted the importance of continued symptom monitoring throughout therapy. Clinicians underestimate the incidence of nausea, which is not as well controlled as emesis.