Low Emetic Risk Research Articles

Development of the serotonin release assay with enterochromaffin cell-rich human intestinal organoids for the risk evaluation of drug-induced emesis.

Drug-induced emesis is one of the major symptoms of gastrointestinal toxicity. Preclinical risk assessment of emesis has been challenging owing to the lack of suitable animal models or in vitro assay systems. One of the triggers of emesis is an excessive serotonin (5-HT) release from enterochromaffin (EC) cells in the intestinal tract, which activates the vomiting center in the brain stem and elicits the vomiting reflex. Here, we propose a 5-HT release assay using human jejunal organoids that are preferentially differentiated into EC cells. In this assay, EC cell-rich organoids were stimulated with emetic risk drugs, and 5-HT release into the media was quantified, along with cellular ATP level and LDH leakage. Anaplastic lymphoma kinase (ALK)/ROS1 tyrosine kinase inhibitors (TKIs) have been reported to exhibit different probabilities of emesis in clinical settings. We demonstrated that 5-HT release from EC cell-rich organoids could qualitatively distinguish between drugs with high or low emetic risk. The results indicated that 5-HT release by ALK/ROS1-TKIs tended to occur prior to the onset of LDH leakage from EC cell-rich organoids, suggesting that 5-HT release was not simply a result of cell bursting. Epidermal growth factor receptor (EGFR) TKIs exhibit a lower potency for inducing 5-HT release, which is consistent with their low emetic risk. In summary, the use of EC cell-rich organoids in 5-HT release assays may prove to be a valuable tool in predicting drug-induced emesis in humans during the drug development.

Prevalence of Chemotherapy-Induced Nausea and Vomiting: An Algerian Study

Prevalence of chemotherapy-induced nausea and vomiting Prospective study at Kasr El Hiran hospital in Laghouat the objective was to study the prevalence of chemotherapy-induced nausea and vomiting (CINV), determine if the prescriptions in our department comply with the recommendations of expert societies, and evaluate the influence of certain patient-specific factors on the occurrence of CINV. This is a prospective observational study conducted at the day hospital of the medical oncology service at EPH Kasr El Hiran Laghouat, spanning a period of 3 months from September 21 to December 21, 2022. At the end of this study, 50 women and 18 men were interviewed, with a mean age of 49.40 years. Breast cancer was the most frequent underlying neoplastic pathology (50%). The majority of chemotherapy protocols used were classified as low emetic risk (44.11%). The prevalence of CINV was 79%, of which 51.9% occurred in the delayed phase. According to our results, none of the risk factors appear to have an influence on the prevalence of CINV, and the prescriptions are not in compliance with the recommendations of expert societies. Our results indicate that the management of CINV remains overall unsatisfactory and could be improved by providing increased accessibility to aprepitant.

2023 Updated MASCC/ESMO Consensus Recommendations: prevention of radiotherapy- and chemoradiotherapy-induced nausea and vomiting

PurposeRadiotherapy and chemoradiotherapy-induced nausea and vomiting (RINV and C-RINV) are common and distressing, and there is a need for guidance for clinicians to provide up to date optimal antiemetic prophylaxis and treatment. Through a comprehensive review of the literature concerning RINV and C-RINV, this manuscript aims to update the evidence for antiemetic prophylaxis and rescue therapy and provide a new edition of recommendations for the MASCC/ESMO antiemetic guidelines for RINV and C-RINV.MethodsA systematic review of the literature including data published from May 1, 2015, to January 31, 2023, was performed. All authors assessed the literature.ResultsThe searches yielded 343 references; 37 met criteria for full article review, and 20 were ultimately retained. Only one randomized study in chemoradiation had the impact to provide new recommendations for the antiemetic guideline. Based on expert consensus, it was decided to change the recommendation for the “low emetic risk” category from “prophylaxis or rescue” to “rescue” only, while the drugs of choice remain unchanged.ConclusionAs for the previous guideline, the serotonin receptor antagonists are still the cornerstone in antiemetic prophylaxis of nausea and vomiting induced by high and moderate emetic risk radiotherapy. The guideline update provides new recommendation for the management of C-RINV for radiotherapy and concomitant weekly cisplatin. To avoid overtreatment, antiemetic prophylaxis is no longer recommended for the “low emetic risk” category.

A cross-sectional study on effectiveness of antiemetic regimens for chemotherapy-induced nausea and vomiting: A single-center retrospect study of 1,000 patients.

e24100 Background: Chemotherapy-induced nausea and vomiting (CINV) is a common symptom in patients who undergoing chemotherapy, it is very important to control CINV to maintain dose intensity and patients' quality of life. To analyse the current situation of CINV for the tumor patients who undergoing chemotherapy, we used a cross-sectional survey to assess CINV status in those patients, and whether the drugs used by doctors in each department met the guidelines, and compared the efficacy of different antiemetic regimens on acute and delayed CINV overall post-chemotherapy periods. Methods: 1,000 patients were randomly selected from 5,468 patients with chemotherapy discharged from different departments of Zhejiang cancer hospital in China between April 1 and April 30, 2019, and there were 87 responses totally. Medical records were collected on patient’s department (internal medicine, surgery, radiotherapy, interventional), chemotherapy regimens, anti-vomiting program, etc. Patients' feedbacks were recorded by CTCAE4.03 standard using MASCC antiemetic tool (Mat). Participants reported the frequency, severity, and impact on daily life of CINV from the day of chemotherapy administration up to 5 days thereafter and nausea and vomiting, as well as pharmacologic and chemotherapy used. Results: A total of 66 antineoplastic drugs were investigated, of which 52 were given intravenously and 14 orally.There were 9, 7, 50 drugs with high, moderate and low emetic risk respectively.The most prescribed prophylactic regimens for the management of CINV were aprepitant, 5-HT3R, H1-RA and dexamethasone and metoclopramide. The overall incidence of CINV were 44.34%, 24.57% and 39.66% patients reported nausea or vomiting in the acute and delayed phases. 19.89% patients had both acute and delayed CINV. The consistency rate of antiemetic with guideline was 63.19% in internal medicine department, 61.41% in surgery department and 52.91% in radiotherapy department, which showed a significant gap between the actual use of drugs and the recommended guidelines(P = 0.001). In 875 patients, 518 patients received guideline recommended antiemetic regimen, the CINV rates of complete response (CR), defined as no vomiting with no rescue medication, were 61.58%. While the CR rates in other 357 patients were 47.06%(P < 0.001). Nausea was more frequent across the overall observation period (43.77% VS 18.86%). However, vomiting was more sever and had a greater impact on life than nausea. Conclusions: Overall, adherence to the guideline recommendations in different departments were poor with varying degrees. Future studies should set hard outcomes, such as the absence of any symptoms, as a primary end point. The standardized management of CINV in patients need to be further strengthened and doctors need to use drugs more regularly to reduce the occurrence of CINV in patients.

A cross-sectional study on the effectiveness of antiemetic regimens for chemotherapy-induced nausea and vomiting: A single center retrospect study of 1,000 patients.

e24055 Background: Chemotherapy-induced nausea and vomiting (CINV) is a common symptom in patients who undergoing chemotherapy, it is very important to control CINV to maintain dose intensity and patients' quality of life. To analyse the current situation of CINV for the tumor patients who undergoing chemotherapy, we used a cross-sectional survey to assess CINV status in those patients, and whether the drugs used by doctors in each department met the guidelines, and compared the efficacy of different antiemetic regimens on acute and delayed CINV overall post-chemotherapy periods. Methods: 1,000 patients were randomly selected from 5,468 patients with chemotherapy discharged from different departments of Zhejiang cancer hospital in China between April 1 and April 30, 2019, and there were 87 responses totally. Medical records were collected on patient’s department (internal medicine, surgery, radiotherapy, interventional) , chemotherapy regimens, anti-vomiting program, etc. Patients' feedbacks were recorded by CTCAE4.03 standard using MASCC antiemetic tool (Mat). Participants reported the frequency, severity, and impact on daily life of CINV from the day of chemotherapy administration up to 5 days thereafter and nausea and vomiting, as well as pharmacologic and chemotherapy used. Results: A total of 66 antineoplastic drugs were investigated, of which 52 were given intravenously and 14 orally.There were 9, 7, 50 drugs with high, moderate and low emetic risk respectively.The most prescribed prophylactic regimens for the management of CINV were aprepitant, 5-HT3R, H1-RA and dexamethasone and metoclopramide. The overall incidence of CINV were 44.34%, 24.57% and 39.66% patients reported nausea or vomiting in the acute and delayed phases. 19.89% patients had both acute and delayed CINV. The consistency rate of antiemetic with guideline was 63.19% in internal medicine department, 61.41% in surgery department and 52.91% in radiotherapy department, which showed a significant gap between the actual use of drugs and the recommended guidelines(P = 0.001). In 875 patients, 518 patients received guideline recommended antiemetic regimen, the CINV rates of complete response (CR), defined as no vomiting with no rescue medication, were 61.58%. While the CR rates in other 357 patients were 47.06%(P < 0.001). Nausea was more frequent across the overall observation period(43.77% VS 18.86%). However, vomiting was more sever and had a greater impact on life than nausea. Conclusions: Overall, adherence to the guideline recommendations in different departments were poor with varying degrees. Future studies should set hard outcomes, such as the absence of any symptoms, as a primary end point.The standardized management of CINV in patients needs to be further strengthened and doctors need to use drugs more regularly to reduce the occurrence of CINV in patients.

Impact of the Oncology Care Model on use of bone supportive medications, antiemetics, and growth factors.

1517 Background: The Oncology Care Model (OCM) is a voluntary, episode-based alternative payment model for cancer care launched by the Centers for Medicare & Medicaid Services in July 2016. OCM incentivizes participating practices to reduce spending during chemotherapy treatment while maintaining quality of care. We evaluated the impact of OCM on the use of costly supportive care medications. Methods: Using 100% Medicare claims (2013-2019), we evaluated use of outpatient supportive care medications during chemotherapy episodes assigned to OCM practices (n = 186) or propensity-matched comparison practices (n = 534). For bone supportive medications, we evaluated use of bisphosphonates and/or denosumab in beneficiaries with bone metastases from breast, lung, or prostate cancer. For anti-emetic drugs, we evaluated prophylactic use of neurokinin-1 (NK1) antagonists and long-acting (LA) serotonin antagonists. For white blood cell growth factors (GCSFs), we evaluated prophylactic use in beneficiaries starting chemotherapy for breast, lung, or colorectal cancer; we separately evaluated use of biosimilar (vs originator) filgrastim. Analyses employed the difference-in-differences (DID) approach, excepting the filgrastim biosimilar analysis where we assessed the adoption trend. Results: There was no OCM impact on receipt of any bone supportive medication (denosumab or bisphosphonate) among beneficiaries with bone metastases; however, OCM led to a relative decrease in use of denosumab for breast cancer (DID = -5.0 percentage points [90% CI -7.1, -2.8]), prostate cancer (-4.0 percentage points [90% CI -5.9, -2.2]), and lung cancer (-4.1 percentage points [90% CI -7.4, -0.9]). In beneficiaries starting chemotherapy regimens with high or moderate emetic risk, OCM led to reductions in prophylactic use of NK1 antagonists and LA serotonin antagonists (e.g. 6.0 percentage point reduction in use of NK1 antagonists during high emetic risk chemotherapy [90% CI -9.0, -3.1]); there was no impact on antiemetic use during low emetic risk chemotherapy. There was no OCM impact on use of prophylactic WBC growth factors among beneficiaries receiving chemotherapy with high risk for febrile neutropenia (FN). Among beneficiaries receiving chemotherapy with intermediate risk for FN, OCM led to a 7.6 percentage point reduction in prophylactic GCSF use for patients with breast cancer (90% CI -12.6, -2.7); however, there was no OCM impact on prophylactic GCSF use in patients with lung or colorectal cancer. Among beneficiaries receiving filgrastim, OCM led to faster adoption of biosimilar vs. originator filgrastim (differential trend estimate 2.6%, 90% CI 1.0, 4.4). Conclusions: OCM led to reduced use of some high cost supportive care medications, with patterns suggesting more value-conscious care. Alternative payment models have potential to drive value-based changes in medication use during cancer care.

Assessment of the Adherence Rate of Acute Chemotherapy Induced Nausea and Vomiting Prophylaxis Regimens by Medical Team to NCCN Clinical Recommendations: Cross-Section Observation

Background: Chemotherapy induced nausea and vomiting (CINV) is still distressing adverse effect for patients. Thus, we conducted this study to assess the compliance of CINV prophylaxis patterns with NCCN guideline. Methods: 136 Patients with any kind of malignancy who undergoes chemotherapy in Shahid Ghazi hospital, Tabriz, Iran, were included in this study. Adherence rate to the NCCN guideline of antiemetic therapy for different emetogenic potential chemotherapy regimens was evaluated. Results: All patients received their prophylaxis 30 min before chemotherapy, which is completely adherent to guideline. Hematological malignancies were associated with higher adherence rate (P=0.032). For high and moderate emetic risk patients, dexamethasone and ondansetron were remarkably under-dosed, whereas Granisetron was over-dosed. Adherence rate to guideline in high and moderate and minimal emetic risk chemotherapy was 72.3%, 22.9% and 69.2% respectively. None of low emetic risk patients received guideline compliant prophylaxis. In all emetic risk levels, 50 (36.8%) patients received guideline adherent prophylaxis. Conclusion: As results indicated, adherence rate wasn’t optimal. Available dosage form of a medication has great impact on appropriate prescription. Thus, it is suggested for pharmaceutical companies to be informed about recent guidelines’ updates and subsequently produce proper dosage forms for different indications.

The Effects of Peppermint Oil on Nausea, Vomiting and Retching in Cancer Patients Undergoing Chemotherapy: An Open Label Quasi–Randomized Controlled Pilot Study

ObjectivesThe current study evaluated the effects of peppermint oil on the frequency of nausea, vomiting, retching, and the severity of nausea in cancer patients undergoing chemotherapy. DesignA quasi-randomized controlled study. SettingPatients were recruited from the ambulatory chemotherapy unit of a public hospital located (Batman, Turkey) between September 2017 and September 2018. InterventionsThe participants in the intervention group applied one drop the aromatic mixture on the spot between their upper lip and their nose, three times a day for the five days following chemotherapy administration, in addition to the routine antiemetic treatment. Participants in the control group underwent only the routine antiemetic treatment. Main outcome measures VAS-the severity of nausea and the Index of Nausea, Vomiting, and Retching. ResultsThe VAS nausea score was significantly lower after peppermint oil applying in the patients receiving Folfirinox (treatment effect (mean dif.): 4.00±2.28; P<0.001), Paclitaxel-Trastuzumab (treatment effect (mean dif.): 1.70±0.90; P=0.014), Carboplatin-Paclitaxel (treatment effect (mean dif.): 3.71±1.41; P<0.001), and Cyclophosphamide-Adriamycin (treatment effect (mean dif.): 1.41±0.73; P=0.005) excluding cisplatin scedule (treatment effect (mean dif.): 0.56±2,18; P=0.642). We detected a statistical significant difference in the change in frequency of nausea, vomiting, retching in the other all schedules excluding cisplatin schedule (P<0.05). ConclusionsThe peppermint oil was significantly reduced the frequency of nausea, vomiting, retching and the severity of nausea in cancer patients undergoing chemotherapy. Therefore, usage of peppermint oil together with antiemetics after chemotherapy with moderate and low emetic risk may be recommended to cope with CINV.

Radiation-induced nausea and vomiting in head and neck cancer: Is it something worth considering in the intensity modulated radiotherapy era? "A narrative review".

Radiation therapy is one of the cornerstones in the treatment of head and neck squamous cell carcinomas (HNSCC), alone or in combination with chemotherapy or surgery. Technological advances which occurred over the last few decades have increased the efficacy of radiotherapy (RT), particularly, intensity-modulated RT (IMRT). IMRT can deliver treatments on complex tumoral targets with dose escalation while sparing organs at risk; anyway IMRT deposits dose in unpredictable patterns outside of the target volume with the purpose of improving conformality. Radiation-induced nausea and vomiting (RINV) is a frequent albeit neglected side effect of RT that can lead to delays in treatment with serious consequences on cure rates. According to several guidelines (MASCC 2016, NCCN 2018), RT for HNSCC has traditionally been regarded as a low emetic risk treatment. Nevertheless, several works suggest that IMRT could increase RINV. Further studies are needed to define the exact incidence and the detailed pathophysiology of RINV in patients with HNSCC treated with state of art IMRT techniques, with and without concurrent chemotherapy.

P-154 - Evaluation of risk factors predicting delayed chemotherapy-induced nausea and vomiting in patients receiving low emetic risk chemotherapy (LEC): A prospective, observational, multicenter study

Introduction: Chemotherapy-induced nausea and vomiting (CINV) are major adverse effects of cancer chemotherapy, and delayed CINV is a particular problem. The incidence of and the risk factors for delayed CINV in patients undergoing low emetic risk chemotherapy (LEC) are unclear. The aim of this study was to provide information on these topics. Methods: This prospective, observational, and multicenter study was conducted on cancer patients undergoing LEC in 13 medical practices. Between September 2013 and November 2014, 222 patients treated with LEC were enrolled in this study. The participants completed a daily patient diary for 5 days during the first cycle of LEC, describing the daily incidence of CINV (yes/no), severity of nausea (0–100 mm, visual analog scale [VAS]), and the amount of food intake (VAS). Results: A total of 210 patients were assessable. The incidence rate of delayed CINV was 21.4%. A multivariate logistic regression model for delayed CINV demonstrated that the independent risk factors were a history of nausea/vomiting (odds ratio [OR] = 3.22, 95% confidence interval [CI] 1.45–7.13, P = 0.004), Eastern Cooperative Oncology Group performance status score > 1 (OR = 2.23, 95% CI 1.04–4.78, P = 0.04), development of acute CINV (OR = 7.40, 95% CI 2.76–19.80, P < 0.0001), and single-day antiemetic prophylaxis (OR = 3.74, 95% CI 1.49–9.42, P = 0.005). An increase in the number of risk factors was significantly associated with an increased cumulative risk of treatment failure (P < 0.05). The mean VAS scores per day for the severity of nausea and food intake in patients who developed acute CINV and those receiving multiple-day antiemetic prophylaxis tended to be better than those who received single-day antiemetic prophylaxis. Conclusion: Guideline-recommended prophylaxis appeared to control delayed CINV effectively in patients undergoing LEC. However, patients with the risk factors listed above should be carefully observed and treatment should be adjusted according to their symptoms. These data can assist clinicians in making decisions about antiemetic management in the delayed phase for patients undergoing LEC.

A prospective, observational, multicenter study on risk factors and prophylaxis for low emetic risk chemotherapy-induced nausea and vomiting.

The incidence of and the risk factors for nausea and vomiting in patients undergoing low emetic risk chemotherapy (LEC) are unclear. The aim of the study was to provide information on these topics by performing a multicenter, observational, prospective study. The study consisted of patients who were administered first-time LEC that was consistent or inconsistent with current guidelines. Using the visual analog scale, patients recorded their daily food intake and the occurrence and severity of nausea over a 5-day treatment period. The overall incidence of chemotherapy-induced nausea and vomiting did not differ significantly between patients undergoing guideline-consistent (n=89) or guideline-inconsistent (n=121) prophylaxis (30.3 vs. 22.3%, respectively; P=0.19). Logistic regression analysis identified a history of nausea and LEC other than taxanes as independent risk factors associated with nausea and vomiting in patients undergoing LEC. The mean daily visual analog scale scores for nausea severity and a decrease in food intake were <25mm throughout the entire observation period. Guideline-consistent prophylaxis appeared to control nausea and vomiting effectively in patients undergoing LEC. However, patients with a history of nausea and receiving LEC other than taxanes should be carefully observed and treatment should be adjusted according to their symptoms.

Prescription of Prophylactic Antiemetic Drugs for Patients Receiving Chemotherapy With Minimal and Low Emetic Risk

The use of antiemetic drugs for patients receiving chemotherapy with low or minimal emetic risk has been recognized as a growing concern for health care costs and patients' welfare. Relatively few studies have examined antiemetic prophylaxis or treatment of emesis associated with chemotherapy with lower emetic risk. To describe the pattern in Japan of overprescribing prophylactic antiemetic drugs to patients who have received intravenous chemotherapy with minimal or low emetic risk. This secondary analysis of a health insurance claims database linked with the hospital-based cancer registry of 122 designated cancer care hospitals covered the period from September 1, 2010, to December 31, 2012. Data were included from patients who (1) were diagnosed with breast, lung, colorectal, stomach, cervical, or prostate cancer; (2) were 20 years or older at the time of the diagnosis; and (3) received intravenous chemotherapy with minimal or low emetic risk. The data from patients with advanced stage cancer (stage IV) were excluded. Data were analyzed from March 20, 2014, to June 30, 2016. The percentage of chemotherapy administration involving patients prescribed prophylactic antiemetic drugs, namely, a neurokinin 1 receptor antagonist, serotonin receptor antagonist, and/or dexamethasone, was calculated. The costs of potentially unnecessary antiemetic drugs were estimated using the National Health Insurance drug price list for 2011. A total of 8545 patients (5886 women [68.9%] and 2659 men [31.1%]; mean [SD] age, 61.9 [12.8] years) undergoing 73 577 administrations of chemotherapy with minimal emetic risk (2464 patients; 22 619 administrations) or low emetic risk (6081 patients; 50 958 administrations) were identified. Of these, patients who received 24 373 administrations of chemotherapy with a low emetic risk (47.8%) and 633 administrations of chemotherapy with a minimal emetic risk (2.8%) were prescribed serotonin receptor antagonists and dexamethasone. Outpatients in the low emetic risk group underwent more frequent administration of chemotherapy that included prescription of both drugs (53.1% of the chemotherapy; 95% CI, 51.6%-54.7%) compared with inpatients (33.7% of the chemotherapy; 95% CI, 31.7%-35.9%). Consequently, approximately ¥170 million (US $1.6 million) was unnecessarily spent on prophylactic antiemetic drugs for these patients. A substantial number of patients receiving chemotherapy with minimal and low emetic risk were prescribed potentially unnecessary prophylactic antiemetic drugs. The judicious use of these drugs could spare the burden of extra costs and the potential risk for adverse effects for patients.

Japanese Society of Clinical Oncology clinical practice guidelines 2010 for antiemesis in oncology: executive summary.

The purpose of this article is to disseminate the standard of antiemetic therapy for Japanese clinical oncologists. On the basis of the Appraisal of Guidelines for Research and Evaluation II instrument, which reflects evidence-based clinical practice guidelines, a working group of the Japanese Society of Clinical Oncology (JSCO) reviewed clinical practice guidelines for antiemesis and performed a systematic review of evidence-based domestic practice guidelines for antiemetic therapy in Japan. In addition, because health-insurance systems in Japan are different from those in other countries, a consensus was reached regarding standard treatments for chemotherapy that induce nausea and vomiting. Current evidence was collected by use of MEDLINE, from materials from meetings of the American Society of Clinical Oncology National Comprehensive Cancer Network, and from European Society of Medical Oncology/Multinational Association of Supportive Care in Cancer guidelines for antiemesis. Initially, 21 clinical questions (CQ) were selected on the basis of CQs from other guidelines. Patients treated with highly emetic agents should receive a serotonin (5-hydroxytryptamine; 5HT3) receptor antagonist, dexamethasone, and a neurokinin 1 receptor antagonist. For patients with moderate emetic risk, 5HT3 receptor antagonists and dexamethasone were recommended, whereas for those receiving chemotherapy with low emetic risk dexamethasone only is recommended. Patients receiving high-emetic-risk radiation therapy should also receive a 5HT3 receptor antagonist. In this paper the 2010 JSCO clinical practice guidelines for antiemesis are presented in English; they reveal high concordance of Japanese medical circumstances with other antiemetic guidelines that are similarly based on evidence.

Implementation of institutional antiemetic guidelines for low emetic risk chemotherapy with docetaxel: a clinical and cost evaluation

The purposes of this study were to evaluate the effect of implementation of institutional guidelines for low emetic risk chemotherapy with docetaxel and estimate the cost saving for all low emetic risk chemotherapies. We examined the clinical effect of preparing and implementing institutional antiemetic guidelines for the breast cancer patients receiving adjuvant docetaxel therapy. Although the antiemetic medication for such patients used to be ondansetron 4 mg plus dexamethasone 8 mg (OND + DEX), it was changed to dexamethasone (DEX) 12 mg alone after implementation of the institutional guidelines. The effectiveness and adverse effects of DEX alone (56 patients, 205 courses) were compared with those of OND + DEX (41 patients, 151 courses). The cost saving was calculated from the antiemetic costs in both groups. The annual cost saving was estimated from the number of all low emetic risk chemotherapies in a year. The incidences of nausea (19.5% versus 16.1%), vomiting (2.4% versus 0%), constipation (34.1% versus 30.4%), and insomnia (17.1% versus 17.9%) were not significantly different between the OND + DEX group and DEX alone group. In all low emetic risk chemotherapies, US $78,883 of potential cost saving was estimated in the first year after changing the antiemetic treatment. The present results suggest that DEX alone is equally effective for preventing nausea and vomiting and less expensive compared with a 5-HT(3) receptor antagonist plus DEX in low emetic risk chemotherapy with docetaxel.

Emesis induced by low or minimal emetic risk chemotherapy

For patients treated with low or minimally emetogenic chemotherapy there is little evidence from clinical trials supporting the choice of a given antiemetic therapy or of any treatment at all. The panel recognized the necessity of considering the introduction into clinical practice of new agents in these categories, particularly oral cytotoxic agents and targeted biological agents and also the possibility of over-treatment with antiemetics. There was consensus among panel members regarding the recommended treatment for patients receiving chemotherapy agents with low and minimal emetic risk. Patients without a history of nausea and vomiting for whom minimally emetic risk chemotherapy is prescribed should not routinely receive antiemetic prophylaxis. A single agent such as a low-dose corticosteroid is suggested for patients receiving agents of low emetic risk. If nausea and vomiting occurs during subsequent cycles of chemotherapy, prophylaxis with a single agent such as a substituted benzamide, a corticosteroid, or a phenothiazine should be administered. Only patients with persistent nausea and vomiting despite treatment with these recommended agents should receive a 5-HT3 receptor antagonist in the following cycles.