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Antiemetics: American Society of Clinical Oncology Focused Guideline Update
Paul J Hesketh1, Kari Bohlke1, Gary H Lyman1
1Paul J. Hesketh, Lahey Hospital and Medical Center, Burlington, MA; Kari Bohlke and Mark R. Somerfield, American Society of Clinical Oncology, Alexandria; Michael A. Danso, Virginia Oncology Associates, Norfolk and Virginia Beach, VA; Gary H. Lyman, Fred Hutchinson Cancer Research Center and University of Washington, Seattle, WA; Ethan Basch, University of North Carolina at Chapel Hill, Chapel Hill, NC; Maurice Chesney, patient representative, Saunderstown, RI; Rebecca Anne Clark-Snow, University of Kansas Cancer Center, Westwood, KS; Karin Jordan, University Hospital, Martin-Luther-University Halle-Wittenberg, Halle, Germany; and Mark G. Kris, Memorial Sloan Kettering Cancer Center, New York, NY.
Purpose:
To update a key recommendation of the American Society of Clinical Oncology antiemetic guideline. This update addresses the use of the oral combination of netupitant (a neurokinin 1 [NK1] receptor antagonist) and palonosetron (a 5-hydroxytryptamine-3 [5-HT3] receptor antagonist) for the prevention of acute and delayed nausea and vomiting in patients receiving chemotherapy.
Methods:
An update committee conducted a targeted systematic literature review and identified two phase III clinical trials and a randomized phase II dose-ranging study.
Results:
In one phase III trial, the oral combination of netupitant and palonosetron was associated with higher complete response rates (no emesis and no rescue medications) compared with palonosetron alone in patients treated with anthracycline plus cyclophosphamide chemotherapy (74% v 67% overall; P = .001). In another phase III trial, the oral combination of netupitant and palonosetron was safe and effective across multiple cycles of moderately or highly emetogenic chemotherapies. In the phase II dose-ranging study, each dose of netupitant (coadministered with palonosetron 0.50 mg) produced higher complete response rates than palonosetron alone among patients receiving cisplatin-based chemotherapy. The highest dose of netupitant (ie, 300 mg) was most effective.
Recommendations:
All patients who receive highly emetogenic chemotherapy regimens (including anthracycline plus cyclophosphamide) should be offered a three-drug combination of an NK1 receptor antagonist, a 5-HT3 receptor antagonist, and dexamethasone. The oral combination of netupitant and palonosetron plus dexamethasone is an additional treatment option in this setting. The remaining recommendations from the 2011 ASCO guideline are unchanged pending a full update. Additional information is available at www.asco.org/guidelines/antiemetics and www.asco.org/guidelineswiki.