nausea/vomiting - chemotherapy induced
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Epidemiology
Pathology
- stimulation of intestinal lining
- stimulation of the chemoreceptor trigger zone (CTZ)
- perturbation of the vestibular apparatus
- effects on cerebral cortex
Management
- hydration is probably the most effective antiemetic[1]
- ondansetron probably single drug of choice (also see vomiting)
- high-emetic-risk chemotherapy
- cisplatin or anthracycline combined with cyclophosphamide
- 4 drug combination of:
- continue dexamethasone & olanzapine on days 2-4[2]
* continue ondansetron even if refractory to ondansetron [NEJM Knowledge+,3]
- moderate-emetic-risk chemotherapy
* continue ondansetron even if refractory to ondansetron [NEJM Knowledge+,3]
- breakthrough nausea/vomiting (not reponsive to prophylactic prochlorperazine)
- intravenous palonsetron + dexamethasone [NEJM Knowledge+,3,4]
- olanzapine[2]
- aprepitant, lorazepam, a dopamine receptor antagonist, dronabinol, or nabilone in patients with continued nausea/vomiting despite adequate hydration & olanzapine[2]
- fosaprepitant (precursor of aprepitant) 150 mg weekly IV infusion[5]
- high-emetic risk radiation therapy
- 2 drug combination before each fraction & on the day after each fraction
- 5-HT3 receptor anagonist (ondansetron)
- dexamethasone[2]
- 2 drug combination before each fraction & on the day after each fraction
- concurrent radiation & chemotherapy
- children:
- 3 drug combination of
- ondansetron + dexamethasone if aprepitant contraindicated
- palonosetron + aprepitant if dexamethasone contraindicated
- prophylaxis: prochlorperazine
More general terms
Additional terms
References
- ↑ 1.0 1.1 Geriatric Review Syllabus, 9th edition (GRS9) Medinal-Walpole A, Pacala JT, Porter JF (eds) American Geriatrics Society, 2016
- ↑ 2.0 2.1 2.2 2.3 2.4 2.5 2.6 2.7 Anello J, Feinberg B, Heinegg J et al Antiemetics in Adults and Children Guidelines on antiemetics by the American Society of Clinical Oncology. Medscape: New Guidelines and Recommendations, August 2017. http://reference.medscape.com/viewarticle/884517
- ↑ Navari RM, Aapro M Antiemetic Prophylaxis for Chemotherapy-Induced Nausea and Vomiting. N Engl J Med 2016;374:1356-67 PMID: https://www.ncbi.nlm.nih.gov/pubmed/27050207 https://www.nejm.org/doi/pdf/10.1056/NEJMra1515442
- ↑ Hesketh PJ, Kris MG, Basch E et al Antiemetics: American Society of Clinical Oncology Clinical Practice Guideline Update. J Clin Oncol. 2017 Oct 1;35(28):3240-3261. PMID: https://www.ncbi.nlm.nih.gov/pubmed/28759346 Review.
- ↑ 5.0 5.1 Yang Q, Zou X, Xie YL et al Fosaprepitant Weekly vs Every 3 Weeks for the Prevention of Concurrent Chemoradiotherapy-Induced Nausea and Vomiting. A Pilot Randomized Clinical Trial. JAMA Netw Open. 2023;6(7):e2326127. July 27 PMID: https://www.ncbi.nlm.nih.gov/pubmed/37498596 https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2807658