HPE CINV Pocket Guide 2018 | Page 35

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 hospitalpharmacyeurope.com | 2018 | 35