Adapting ASCO and NCCN guidelines in institutional antiemetic guidelines benefits patients receiving chemotherapy

Abstract

20508 Background: The primary endpoint of the present study was to determine the impact of adapting ASCO and NCCN guidelines for antiemetics (AE) in our institutional antiemetic guidelines. Methods: The emetic risk of chemotherapy regimens was calculated using the Hesketh classification. AE guidelines were adapted and approved by a multidisciplinary team and the Drugs and Therapeutics Committee. We have compared 2 groups: patients receiving the new adapted institutional AE with those receiving non-established antiemetic treatment. Patients recorded episodes of nausea and vomiting in a diary the day of chemotherapy administration and the following 4 days. Patients also recorded rescue antiemetic medications. Patients completed the Functional Living Index- Emesis (FLIE) questionnaire at baseline and on day 6. The FLIE total scores >108 was defined as ‘no impact on daily functional‘. The main updates of the new adapted AE guidelines included the addition of aprepitant in cisplatin-based schedules, granisetron dose of 1 mg instead of 3 mg or ondansetron and dexametasone dose based on the emetic potential of each chemotherapy protocol. A delayed antiemetic protocol was recommended for each chemotherapy protocol. Results: From February 2007 to August 2007 225 consecutive patients were prospectively included in the study, 119 patients before the implementation of new AE guidelines and 106 patients after. Patients receiving the new AE guidelines achieved a trend for more complete response (defined as no nausea, no vomiting and no AE rescue): 52% vs 66.7% (p=0.065). In the cisplatin-based group, patients receiving the new AE guidelines obtained a statistically significant benefit with the new protocol (47.6% vs 73.3 % [p=0.017]), and less patients presented a reduction in the FLIE score below 108 (42 % vs 24% [p=0.142]). Conclusions: Implementation of revised AE guidelines provides a better control of CINV with higher complete response rate, especially in patients receiving cisplatin-based schedules. No significant financial relationships to disclose.