TABLE 1
Selective recommendations of key guidelines
related to chemotherapy (continued)
MEC Other MEC:
None
LEC Acute phase:
Single dose antiemetic, such as Dex,
5-HT 3 RA or dopamine RA
Delayed phase:
No routine prophylaxis
MiEC
No routine prophylaxis
AC: anthracycline + cyclophosphamide; 5-HT 3 RA: serotonin receptor antagonist; NK 1 RA: Neurokinin
1 receptor antagonist; Dex: dexamethasone; APR: aprepitant; MCP: metoclopramide.
managing nausea/vomiting in
advanced cancer and NCCN
provided recommendations in
the latest update guidelines for
CINV related to oral chemotherapy
drugs. All guidelines have had
updated recommendations for
preventing CINV in children,
high-dose chemotherapy, multiple-
day chemotherapy, radiotherapy
and for breakthrough CINV, and
more details (including dosing
of antiemetics) can be found in
the uploaded guidelines in the
respective websites.
We now better understand
22 | 2019 | hospitalpharmacyeurope.com
(but not completely) the
pathophysiology of CINV. This
has led to the identification of
newer pathways implicated in
the development of nausea and
vomiting, including the NK 1
receptors, alongside the serotonin
5-HT 3 receptors and dopamine
receptors, among others. The
introduction of 5-HT 3 receptor
antagonists in the management
of CINV in the early 1990s has
significantly improved these
symptom outcomes for patients.
Second-generation 5-HT 3 RAs
(that is, palonosetron) have