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ASCO's update to its antiemetics guideline now includes an evaluation of evidence on complementary antiemetic therapy.
Journal of Clinical Oncology recently published ASCO's update to its antiemetics guideline.1 ASCO first published an evidence-based clinical practice guideline on the use of antiemetics for patients with cancer in 1996. ASCO previously updated this guideline in 2006. For its current update, the scope remained largely unchanged and includes nausea and vomiting induced by chemotherapy, radiotherapy, and combination chemotherapy and radiation therapy. The scope now includes an evaluation of evidence on complementary antiemetic therapy.
The guideline is based on a systematic search and review of the literature. The Antiemetics Guideline Update Committee considered literature identified by a systematic review funded by the Agency for Healthcare Research and Quality. In addition to articles from the medical literature, both presentations and posters from the Multinational Association for Supportive Care in Cancer and ASCO Annual Meetings were eligible for inclusion. The primary efficacy outcomes of interest were complete response, emetic control, nausea control, and use of rescue antiemetics.
This most recent update reviews optimal therapy for patients receiving highly emetic chemotherapy, and 5-hydroxytryptamine 3 (5-HT3) antagonist equivalency in the moderately emetogenic setting. Other key questions included the use of neurokinin 1 (NK1) receptor antagonists in the moderately emetogenic and high-dose chemotherapy setting, treatment of radiation-induced nausea and vomiting, and antiemetic therapy for children. The update also reviews evidence regarding three new drug formulations approved by the US Food and Drug Administration since the 2006 update: fosaprepitant, an aprepitant prodrug (an NK1 receptor antagonist); the granisetron transdermal system; and the ondansetron orally disintegrating tablet.
Other changes to recommendations for this update include those listed below. All of the 2006 and 2011 recommendations are listed in Table 1.
For chemotherapy-induced nausea and vomiting:
For radiation-induced nausea and vomiting:
Journal of Clinical Oncology published an Executive Summary of the Guideline Update1. The Executive Summary is brief overview of the complete ASCO Clinical Practice Guideline Update (available online only) and provides a brief discussion of the relevant literature for each recommendations. The complete Guideline Update—including expanded discussion of the literature, a description of methodology, and all cited references—and a Data Supplement with evidence tables and a patient guide are available at www.asco.org/guidelines/antiemetics. A slide set and a table with dosing information are provided in an online Data Supplement to this JOP article.
Antiemetics: ASCO Clinical Practice Guideline Update was developed and written by Ethan Basch, Ann Alexis Prestrud, Paul J. Hesketh, Mark G. Kris, Petra C. Feyer, Mark R. Somerfield, Maurice Chesney, Rebecca Anne Clark-Snow, Anne Marie Flaherty, Barbara Freundlich, Gary Morrow, Kamakshi V. Rao, Rowena N. Schwartz, and Gary H. Lyman.
Data supplements, including evidence tables, and clinical tools and resources can be found at www.asco.org/guidelines/antiemetics.
Although all authors completed the disclosure declaration, the following author(s) indicated a financial or other interest that is relevant to the subject matter under consideration in this article. Certain relationships marked with a “U” are those for which no compensation was received; those relationships marked with a “C” were compensated. For a detailed description of the disclosure categories, or for more information about ASCO's conflict of interest policy, please refer to the Author Disclosure Declaration and the Disclosures of Potential Conflicts of Interest section in Information for Contributors.
Employment or Leadership Position: None Consultant or Advisory Role: Paul Joseph Hesketh, Merck (C), Eisai (C), GlaxoSmithKline (C), Helsinn (C); Mark G Kris, Sanofi-Aventis (C), GlaxoSmithKline (C) Stock Ownership: None Honoraria: None Research Funding: None Expert Testimony: None Other Remuneration: None
Conception and design: Ethan Basch, Paul J. Hesketh, Mark G. Kris, Ann Alexis Prestrud, Gary H. Lyman
Administrative support: Ann Alexis Prestrud, Sarah Temin
Provision of study materials or patients: Mark G. Kris
Collection and assembly of data: Ethan Basch, Paul J. Hesketh, Mark G. Kris, Ann Alexis Prestrud, Gary H. Lyman
Data analysis and interpretation: Ethan Basch, Paul J. Hesketh, Mark G. Kris, Ann Alexis Prestrud, Gary H. Lyman
Manuscript writing: All authors
Final approval of manuscript: All authors