PD1 monoclonal antibodies –
steroids limit the efficacy of
PD1 monoclonal antibodies, 11
olanzapine, avoid concomitant
metoclopramide and haloperidol
• Extended HEC with
cyclophosphamide – guidance
recommends repeated granisetron
extended-release formulations, or
rolapitant
• High-risk and medium-risk oral
Ctx includes TKIs
• 11 new substances, including an
IV formulation of NEPA
• If dexamethasone is not
tolerable, it should be replaced by
olanzapine
• Lorazepam should be used with
caution if cannabinoids are used
• If cyclophosphamide
chemotherapy of high and
moderate risk lasts for three
days for high and two days
for MEC after the last dose of
chemotherapy, patients need to
be protected throughout the full
period of risk.
Nausea, by contrast, is more
difficult to control. Among
patients receiving emetogenic
chemotherapy and treated
effectively with anti-emetics,
nausea is often seen more
frequently than vomiting.
Generally, nausea is more likely
to be seen in younger patients
than older patients, and younger
women being treated for breast
cancer are more prone to nausea
than other groups of patients.
Delayed nausea happens more
often than acute nausea and
is more severe and tends to be
treatment resistant. Therefore
prevention of nausea is a high
priority in clinical research. 5,7
Poorly controlled CINV can also
lead to interruptions in treatment
or discontinuation of therapy as a
result of poor compliance. 12 CINV
can result in fatigue, anorexia,
insomnia, dehydration, electrolyte
imbalance, weakness and weight
loss. 13
Health-related QoL
CINV has a significant negative
impact on health-related QoL,
even when antiemetic therapy
is used after HEC or MEC. 14
Bloechl-Daum et al studied the
effect of CINV on the QoL in
298 patients with cancer – 67 of
whom were treated with HEC
and 231 with MEC. Overall, on
day 6 after chemotherapy, 61% of
patients reported that CINV had
no or minimal impact on daily
life (NIDL), with significantly
fewer HEC patients reporting
NIDL than those receiving MEC
(47.2% versus 64.5% respectively;
p=0.0272). Nausea seemed to have
a greater impact on daily life than
vomiting as indicated by the mean
Functional Living Index-Emesis
(FLIE; a validated nausea- and
vomiting-specific patient-reported
outcome measure): the nausea
domain score for all patients was
50.0 (44.7 for HEC and 51.4 for
MEC; p=0.0024), compared with
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