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Chemotherapy-induced nausea and vomiting control in pediatric patients receiving ifosfamide plus etoposide: a
Priya Patel1,2, Sara R Lavoratore3, Jacqueline Flank1
1Department of Pharmacy, The Hospital for Sick Children, Toronto, Canada.
Insights
Chemotherapy-induced nausea and vomiting (CINV) is common in pediatric patients receiving etoposide and ifosfamide. This regimen is highly emetogenic, necessitating optimized antiemetic prophylaxis for better CINV control.
Area of Science:
- Pediatric Oncology
- Clinical Pharmacology
- Cancer Therapeutics
Background:
- Limited data exists on the emetogenicity of chemotherapy regimens in pediatric populations.
- Etoposide plus ifosfamide is a frequently utilized chemotherapy regimen in pediatric oncology.
- Understanding chemotherapy-induced nausea and vomiting (CINV) is crucial for supportive care in children undergoing cancer treatment.
Purpose of the Study:
- To describe the prevalence of chemotherapy-induced nausea and vomiting (CINV) in pediatric patients treated with a 5-day etoposide plus ifosfamide regimen.
- To evaluate the effectiveness of antiemetic prophylaxis in controlling CINV during both acute and delayed phases.
- To classify the emetogenic potential of this specific pediatric chemotherapy regimen.
Main Methods:
- A cohort of non-chemotherapy-naïve pediatric patients (aged 4-18 years) receiving etoposide (100 mg/m²/day) plus ifosfamide (1800 mg/m²/day) for 5 days was enrolled.
- Antiemetic prophylaxis was administered at the discretion of the treating care team.
- Patients prospectively recorded emetic episodes and nausea severity from the first chemotherapy dose through 7 days post-treatment, assessing acute (0-24h) and delayed (24h-7 days) phases.
Main Results:
- Only 23% of patients achieved complete acute CINV control (no nausea, vomiting, or retching).
- Complete control of chemotherapy-induced vomiting (CIV) and nausea (CIN) during the acute phase was observed in 57% and 27% of patients, respectively.
- Complete delayed CINV control rates were 42%, with specific rates for CIV and CIN at 70% and 42%, respectively.
Conclusions:
- The combination of etoposide (100 mg/m²/day) and ifosfamide (1800 mg/m²/day) administered over 5 days should be classified as a highly emetogenic regimen in pediatric patients.
- The findings highlight suboptimal CINV control with current prophylaxis strategies in this population.
- Optimizing antiemetic prophylaxis selection is essential for improving CINV control in pediatric patients receiving this regimen.
Purpose:
Little evidence exists regarding the emetogenicity of chemotherapy in pediatric patients. This study describes the prevalence of chemotherapy-induced nausea and vomiting (CINV) in pediatric patients receiving etoposide plus ifosfamide over 5 days, a common pediatric regimen.
Methods:
English-speaking, non-chemotherapy-naïve patients aged 4 to 18 years about to receive etoposide 100 mg/m2/day plus ifosfamide 1800 mg/m2/day over 5 days participated. Antiemetic prophylaxis was determined by each patient's care team. Emetic episodes were recorded and nausea severity was assessed by patients beginning with the first chemotherapy dose, continuing until 24 h after the last chemotherapy dose (acute phase) and ending 7 days later (delayed phase). The proportion of patients experiencing complete acute CINV control (no nausea, no vomiting, and no retching), the primary study endpoint, was described. The prevalence of complete chemotherapy-induced vomiting (CIV) and chemotherapy-induced nausea (CIN) during the acute, delayed, and overall (acute plus delayed) phases; complete delayed and overall CINV control; and anticipatory CINV were also determined.
Results:
Twenty-four patients participated; acute CINV was evaluable in 22. Most (75%; 18/24) received a 5-HT3 antagonist plus dexamethasone for antiemetic prophylaxis. Few (23%; 5/22) experienced complete acute CINV control. Complete acute CIV and CIN control were experienced by 57% (13/23) and 27% (6/22) of patients, respectively. Complete delayed CINV, CIV, and CIN control rates were 42% (8/19), 70% (14/20), and 42% (8/19), respectively.
Conclusions:
Our findings support the classification of etoposide 100 mg/m2/day plus ifosfamide 1800 mg/m2/day IV over 5 days as highly emetogenic. This information will optimize antiemetic prophylaxis selection and CINV control in pediatric patients.
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