ASCO guidelines suggest adding olanzapine to antiemetic regimens

Last Updated: 2017-08-16

By Reuters Staff

NEW YORK (Reuters Health) - Adding olanzapine to antiemetic prophylaxis and an expanded role for neurokinin 1 receptor antagonists in patients receiving chemotherapy are among the highlights of the American Society of Clinical Oncology's (ASCO) new practice guidelines on antiemetics.

The guidelines, published online July 31 in the Journal of Clinical Oncology, emphasize the "importance of using the most effective antiemetic regimens that are appropriate for antineoplastic agents or radiotherapy being administered."

"Such regimens," ASCO's Dr. Paul J. Hesketh and colleagues add, "should be used with initial treatment, rather than first assessing the patient's emetic response with less-effective treatment."

ASCO has published several guidelines on antiemetics. For its latest recommendations, which replace the 2015 guidelines, the authors reviewed 41 studies published between November 2009 and June 2016.

The advice on adding olanzapine to treatment for adults on high-emetic-risk chemotherapy is based on a phase 3 randomized controlled trial. The new guidelines also recommend olanzapine for patients with breakthrough nausea and vomiting.

Other updates include:

- Using dexamethasone only on day 1 in adults receiving anthracycline and cyclophosphamide.

- Adding neurokinin 1 receptor antagonists in adults receiving carboplatin area under the curve of at least 4 mg/mL per minute, or high-dose chemotherapy, and in children on high-emetic-risk chemotherapy.

- Adjustments to anatomic regions, risk levels, and antiemetic administration schedules for radiation-induced nausea and vomiting.

- Recommendation for rescue therapy only for patients on low-emetic-risk radiation therapy.

The guideline authors state that there is not enough evidence to recommend medical marijuana, or the U.S. Food and Drug Administration-approved cannabinoids dronabinol and nabiolone, for treating cancer patients with nausea and vomiting due to chemotherapy or radiation. Evidence is also insufficient, according to the authors, for ginger, acupuncture, acupressure, and other complementary or alternative therapies.

For more information from ASCO on the guidelines, visit http://bit.ly/2wakOxq or http://bit.ly/2w9YsvT.

SOURCE: http://bit.ly/2v1666I

J Clin Oncol 2017.