The AngCN Antiemetic Guidelines
|
|
- Brice Blake
- 6 years ago
- Views:
Transcription
1 The AngCN Antiemetic Guidelines Guidelines for the Management of Nausea and Vomiting in Adult Patients Receiving Chemotherapy and/or Radiotherapy AngCN Document Reference: AngCN-CCG-C31
2 CONTENTS 1.0 Introduction 1.1 Scope 1.2 Aims 1.3 Definitions 1.4 Grading of nausea and vomiting 2.0 Antiemetic Risk Assessment and Protocol 2.1 Emetogenic Risk of IV and Oral Chemotherapeutic Agents 2.2 Assessing the emetogenic potential of chemotherapy regimens 2.3 Risk assessment 2.4 Assessing patient risk factors 2.5 Antiemetic categories, approved agents and uses 2.6 Antiemetic regimen selection 2.7 Anticipatory nausea and vomiting 3.0 Management of Antiemetic Failure and Escalation Policy 3.1 Definition of antiemetic failure 3.2 Management of antiemetic failure 4.0 Radiation Induced Nausea and Vomiting 4.1 Principles of Management 4.2 Determinants of emetic risk 4.3 ChemoRadiation 4.4 Guidance 5.0 Adverse Drug Reactions Associated with Commonly used Antiemetics 6.0 Appendices 6.1 Action of antiemetics on main receptor sites 6.0 References 7.0 Acknowledgements
3 1.0 Introduction The following guidelines have been developed for use within the Anglia Cancer Network for adult oncology and haemato-oncology patients receiving chemotherapy and/or radiotherapy. 1.1 Scope The guidelines apply to the use of antiemetics within Trusts delivering appropriate chemotherapy drugs/regimens. GPs should not be requested to prescribe. 1.2 Aims To reduce the risk of emesis and minimise the side effects and complications of antiemetic drugs To ensure appropriate prescribing and administration of antiemetics for patients receiving chemotherapy and/or radiotherapy, as approved through the Anglia Cancer Network Systemic Anti-cancer Therapies group. 1.3 Definitions Acute Nausea and Vomiting (N and V) N and V experienced during the first 24-hour period immediately after chemotherapy administration Delayed N and V N and V that occurs more than 24 hours after chemotherapy and may continue for up to 6 or 7 days after chemotherapy Anticipatory N and V N and V that occurs prior to the beginning of a new cycle of chemotherapy. It is either a learned response following chemotherapy induced N&V on a previous cycle or an anxiety response. It is most common after 3 to 4 cycles of chemotherapy with very badly controlled acute or delayed symptoms Breakthrough N and/or V Development of symptoms (nausea or vomiting), despite standard antiemetic therapy, which require treatment with an additional pharmacological agent Refractory N and V Patients who have failed on both standard and rescue medication
4 1.4 Grading of Nausea and Vomiting Grade Nausea Vomiting 5 Death Death 4 Life-threatening consequences Life-threatening consequences 3 Inadequate oral caloric or fluid intake; IV fluids, tube feedings, or TPN indicated 24 hrs 6 episodes in 24 hrs; IV fluids, or TPN indicated 24 hrs 2 Oral intake decreased without significant weight loss, dehydration or malnutrition; IV fluids indicated <24 hrs 2 5 episodes in 24 h; IV fluids indicated <24 hrs 1 Loss of appetite without alteration in eating habits 1 episode in 24 hrs 1.4 Grading of Nausea and Vomiting Radiation Induced Nausea and Vomiting Guidance...18
5 2.0 Antiemetic Risk Assessment and Protocol 2.1 Emetogenic Risk of IV and Oral Chemotherapeutic Agents It should be noted that appropriate prophylaxis can prevent delayed nausea and vomiting, which is harder to treat. Antiemetic treatment should therefore be escalated rapidly to control nausea and vomiting. Antiemetic therapy needs to be tailored to the treatment regimen used, as these have varying emetogenic potential, and also to the individual patient to whom it is being given. Note: A chemotherapy regimen named in the table in section 2.5 does not imply approval to prescribe. It should be ensured that funding approval has been sought and approved before prescribing. 2.2 Assessing the Emetogenic Potential of Chemotherapy Regimens Level Risk Agent 5 Very High Cisplatin > 60mg/m2 4 High >90% Carmustine > 250 mg/ m 2 Cisplatin > 50mg/m 2 Cyclophosphamide > 1500mg/m 2 Dacarbazine Dactinomycin Epirubicin > 90mg/m 2 Ifosphamide 10 g/ m 2 Mechlorethamide Streptozocin Trabectedin Procarbazine oral 3 Moderate- High 31-90% 2 Low 10-30% 1 Minimal <10% Alemtuzumab Amsacrine Azacitidine Bendamustine Cabazitaxel Carboplatin Carmustine 250 mg/ m 2 Cisplatin 50mg/m 2 Clofarabine Cyclophosphamide mg/m 2 Cytarabine >1g/m 2 Daunorubicin Doxorubicin > 60mg/m 2 Bortezomib Capecitabine Cetuximab Cyclophosphamide IV/PO < 750mg/m 2 Cytarabine < 1g/m 2 Docetaxel Doxorubicin < 60mg/m 2 Etoposide Everolimus Fludarabine Abiraterone Bevacizumab Bexarotene Bleomycin Busulfan (low dose) Chlorambucil Cladribine Dasatinib 5-Fluorouracil Gemcitabine Liposomal Doxorubicin Lapatinib Lenalidomide Mercaptopurine Methotrexate mg/m 2 Mifamurtide Mitomycin C Mitoxantrone Erlotinib Gefitinib Hydroxyurea Ipilimumab Melphalan Mesna (IV) Methotrexate < 50mg/m 2 Nilotinib Epirubicin 90mg/m 2 Eribulin Imatinib Idarubicin Ifosphamide <10 g/ m 2 Irinotecan Melphalan (Single high dose) Methotrexate > 250 mg/m 2 Oxaliplatin Procarbazine oral Temozolomide Vinorelbine oral Paclitaxel Paclitaxel albumin Pemetrexed Pentostatin Rituximab Romidepsin Sunitinib Tegafur Teniposide Thalidomide Topotecan Trastuzumab Pazopanib Temsirolimus Vemurafenib Vinblastine Vincristine Vinorelbine Vinflunine Formatted: Italian (Italy) Formatted: English (U.K.) Formatted: Italian (Italy) Formatted: English (U.K.) Formatted: English (U.K.) Formatted: Italian (Italy) Formatted: Italian (Italy)
6 Note: Drug combinations have an additive emetic effect. If drugs from the same category are combined, the regimen is classified at a higher emetic risk. If drugs are from different categories, the emetic risk is according to the most emetic drug in the combination. 2.3 Risk Assessment Certain risk factors can be used to predict those patients likely to be more susceptible to the emetogenic effects of chemotherapy or radiotherapy: Female gender Young (<30 years old) History of nausea and vomiting (e.g. sickness in pregnancy, motion sickness) Poor control of emesis with prior chemotherapy or radiotherapy Anxiety 2.4 Assessing Patient Risk Factors Risk Factor Action Chemotherapy induced nausea and vomiting (CINV) after previous chemotherapy If level < 4 add one to level Female gender Young age< 30 Drink Little or no Alcohol If level 3 or more then add one to level Anxiety History of Motion Sickness High level of anxiety prior to chemotherapy Add Lorazepam 1mg or Levomepromazine mg P.O. 1 hour before chemotherapy NB Excess alcohol intake reduces emetic risk: Women >14units/week, Men >21units/wk Other Potential Risk Factors: - Partial or complete bowel obstruction - Brain metastases - Electrolyte imbalance (hypercalcaemia, hyperglycaemia, hyponatraemia and uraemia) - Opiod induced nausea and vomitting
7 2.5 Antiemetic Categories, Approved Agents and Uses Many chemotherapy regimens for haemato-oncology patients incorporate corticosteroid treatment (commonly with prednisolone or dexamethasone). These patients should NOT receive dexamethasone as part of their antiemetic regimen even if the chemotherapy regimen falls into Category 2, 3 or 4 in section 2.2 (the Emetogenic Risk table). Generally no patient with acute leukaemia should receive dexamethasone as an antiemetic even if the drug/regimen falls into category 2, 3 or 4 (although some of these regimens may include a corticosteroid as part of the anti-cancer treatment). Drug / Regimen Tumour Site Antiemetic level Comments or special instructions A ABCM Haemato-onc 3 AB week only ABCM Haemato-onc 1 CM week only Abiraterone Urology (prostate) 1 ABVD Haemato-onc 4 AC Breast 3 ACE Germ cell 4 ADE (AML 15) Haemato-onc 3 No dexamethasone as antiemetic Alemtuzumab Haemato-onc 3 Amsacrine Haemato-onc 3 Asparaginase Haemato-onc 1 Azacitidine Haemato-onc 3 B BCG intravesical Urology 1 Bendamustine Haemato-onc 3 BEP Germ cell 5 Including 3-day and 5-day Bevacizumab Lower GI 1 In combination with fluoropyrimidine based chemotherapy Bexarotene Skin (cutaneous T 1 cell lymphoma) Bleomycin Various 1 Dexamethasone 8mg PO premedication to prevent reactions Bortezomib Haemato-onc 2 Busulfan (low dose) Haemato-onc 1 C Cabazitaxel Urology (prostate) 3 No dexamethasone TTO as antiemetic as regimen includes prednisolone CAP Lung (thymoma) 4 Capecitabine Lower GI 1 Capecitabine / Various 4 Cisplatin Capecitabine / Lower GI / Upper 2 Irinotecan GI Capecitabine / Breast 1 Lapatinib Carboplatin Germ cell / Gynaecology / Breast Carboplatin / Breast 3 3 Includes high dose e.g. AUC7 & AUC10
8 Docetaxel Carboplatin / Lung / Etoposide Neuroendocrine Carboplatin / 5-FU Head & neck / Upper GI Carboplatin (weekly with RT) Carmustine Haemato-onc / 3 3 Head & neck 4 Omit post-chemotherapy dexamethasone 3 ( 250mg/m 2 ) CNS 4 (>250mg/m 2 ) CAV Lung 3 CDT Haemato-onc 1 Cetuximab Lower GI 2 Cetuximab / Irinotecan / Capecitabine Lower GI 2 Cetuximab / Lower GI 2 Irinotecan / 5FU Cetuximab / Lower GI 3 Oxaliplatin / 5FU Chlorambucil Haemato-onc 1 ChlVPP Haemato-onc 1 CHOP Haemato-onc 4 No dexamethasone as antiemetic CIA Gynaecology 4 Cisplatin Dose > Various 5 60mg/m 2 Cisplatin 60mg/m 2 Various 4 Cisplatin (weekly with RT) Cisplatin / Docetaxel / 5FU Cisplatin / Gynaecology / Doxorubicin Head & Neck Cisplatin / Etoposide Gyanecology / Lung / Neuroendocrine Head & Neck / 3 Omit post-chemotherapy Gynaecology dexamethasone Head & Neck 5 Cisplatin weekly / Gynaecology 4 oral etoposide Cisplatin / 5-FU Various 5 All regimens Cisplatin / Gynaecology 3 Topotecan Cladribine Haemato-onc 1 Clofarabine Haemato-onc 3 CMD Haemato-onc 2 No dexamethasone as antiemetic CMF Breast 2 CMV Urology (bladder) 5 C-VAMP Haemato-onc 3 No dexamethasone as antiemetic CVD Neuroendocrine 4 CVP Haemato-onc 3 No dexamethasone as antiemetic Cyclophosphamide - Oral only Cyclophosphamide - IV doses <1500mg/m 2 Cyclophosphamide - IV doses >1500mg/m 2 Various 1 Various 3 Haemato-onc 4 4 5
9 Cyclophosphamide / Breast 3 Docetaxel Cytarabine - IV doses <1000mg/m2 Haemato-onc 2 No dexamethasone as antiemetic if AML Cytarabine - IV doses 1000mg/m 2 Haemato-onc 3 No dexamethasone as antiemetic if AML C-Z-DEX Haemato-onc 3 No dexamethasone as antiemetic D DA (AML 15/16) Haemato-onc 3 No dexamethasone as antiemetic Dacarbazine Melanoma 4 Dactinomycin Gestational 4 trophoblastic tumours Dasatinib Haemato-onc 1 Daunorubicin / Haemato-onc 3 No dexamethasone as antiemetic Clofarabine (AML 16) Daunorubicin Haemato-onc 3 De Gramont Lower GI 1 (standard/modified) Docetaxel Breast / Upper GI 2 Dexamethasone 8mg PO BD for 3 days starting day before docetaxel + post chemo domperidone Docetaxel Urology (prostate) 2 Given the concurrent use of prednisolone, the recommended premedication regimen is oral dexamethasone 8 mg, 12 hours, 3 hours and 1 hour before the docetaxel + domperidone Docetaxel / Capecitabine Breast 2 Dexamethasone 8mg PO BD for 3 days starting day before docetaxel Docetaxel / Carboplatin Lung / Gynaecology + domperidone 3 Dexamethasone 8mg PO BD for 3 days starting day before docetaxel + ondansetron / domperidone Docetaxel / Cisplatin Lung 4 Dexamethasone 8mg PO BD for 3 days starting day before docetaxel + ondansetron / domperidone Docetaxel / Gemcitabine Sarcoma / Gynaecology Docetaxel / Upper GI 3 Irinotecan Doxorubicin Various 3 Doxorubicin weekly Breast 2 E EC Breast 3 ECarboF Upper GI/Unknown Primary ECarboX Upper GI/ 4 Unknown Primary ECE Lung (thymoma) 4 ECF Upper GI/Unknown Primary 4 2 Dexamethasone 8mg PO BD for 3 days starting day before docetaxel + post chemo domperidone 3
10 ECX Upper GI/ 4 Unknown Primary EDP + Mitotane Neuroendocrine 3 EMA-CO Gestational 4 EMA weeks only Trophoblastic Tumour EMA-CO Gestational 2 CO weeks only Trophoblastic Tumour EOF Upper GI 3 EOX Upper GI 3 EP Germ cell / lung 4 Epi-CMF Breast 3 Epirubicin only Epi-CMF Breast 2 CMF only Epirubicin Breast 3 Epirubicin / Gynaecology 3 Carboplatin Epirubicin (weekly) Breast 2 Eribulin Breast 3 Erlotinib Lung 1 ESHAP Haemato-onc 4 No dexamethasone as antiemetic Etoposide - Oral Various 1 only Etoposide - IV only Various 2 (except high dose etoposide for germ cell) Etoposide Germ cell 3 High dose 1.6g/m 2 etoposide EV Lung 2 Everolimus Renal 1 F FAD Haemato-onc 3 No dexamethasone as antiemetic FC (Fludarabine / Haemato-onc 3 Cyclophosphamide) FEC - All epirubicin Breast 3 doses up to 75mg/m2 FEC 100 Breast 4 FEC-T Breast 4 FLAG-Ida (AML 15) Haemato-onc 3 No dexamethasone as antiemetic Fludarabine - Oral Haemato-onc 1 and IV 5-Fluorouracil Various 1 Includes continuous infusional 5- FU, weekly bolus, and 5-FU + RT regimens FMD Haemato-onc 2 No dexamethasone as antiemetic G GCP Germ cell 3 Dexamethasone 20mg IV pre 3 weekly paclitaxel (instead of 8mg) plus other antiemetics Gefitinib Lung 1 Gemcitabine Various 2 Gemcitabine / Lung / Breast / 3 Carboplatin Gyanecology Gemcitabine / Cisplatin Various 4
11 Gemcitabine / Breast / Bladder / 2 Paclitaxel Germ Cell Gem-TIP Germ Cell 4 Dexamethasone 20mg IV pre 3 weekly paclitaxel (instead of 8mg) plus other antiemetics Gemtuzumab Haemato-onc 1 Ozogamicin (Mylotarg ) H Hydroxycarbamide Haemato-onc 1 (Hydorxyurea) Hyper-CVAD + Haemato-onc 3 No dexamethasone as antiemetic Rituxumab I Idarubicin Haemato-onc 3 No dexamethasone as antiemetic if AML Ifosfamide Various 3 Ifosfamide / Sarcoma 3 Doxorubicin Imatinib GIST / Haematoonc 1 Interferon alfa Renal 1 Ipilimumab Melanoma 1 IPO Germ Cell 3 Irinotecan Lower GI 3 Irinotecan / 5FU (FOLFIRI) Lower GI 3 Includes De Gramont & weekly bolus 5FU Irinotecan/mitomycin Upper GI 3 C Irinotecan (weekly) Lower GI 2 IVE Haemato-onc 3 L Lapatinib Breast 1 Lenalidomide Haemato-onc 1 Liposomal Gynaecology 2 Doxorubicin Liposomal Gynaecology 3 Doxorubicin / Carboplatin Lomustine CNS 1 M MACE (AML 15) Haemato-onc 2 No dexamethasone as antiemetic Melphalan Haemato-onc 1 Including PO melphalan + prednisolone; IV melphalan + dexamethasone. Mercaptopurine Haemato-onc 1 No dexamethasone as antiemetic if ALL Methotrexate - oral Various 1 and IV doses <300mg/m 2 only. Methotrexate - IV doses > 300mg/m 2 Haemato-onc 3 No dexamethasone as antiemetic if ALL MidAC (AML 15) Haemato-onc 3 No dexamethasone as antiemetic Mifamurtide Sarcoma 3 MiniBEAM Haemato-onc 3 Day 1 & 6 only MiniBEAM Haemato-onc 2 Day 2 5 only
12 Mitomycin C - Urology 1 Intravesical only Mitomycin C / Lower GI 2 For Mitomycin C weeks only Capecitabine Mitomycin C/ 5-FU Lower GI 2 All regimens. For Mitomycin C weeks only. Mitoxantrone Various 2 MM Breast 2 MMM Breast 2 MVAC Urology (bladder) 5 MVC Urology 4 MVP Mesothelioma 4 N Nilotinib Haemato-onc 1 O OMB Germ cell 3 Oxaliplatin Lower GI 3 Oxaliplatin / Lower GI 3 Capecitabine (XELOX) Oxaliplatin / 5FU Lower GI 3 Includes De Gramont & weekly bolus 5FU. P Paclitaxel Various 2 Dexamethasone 20mg IV pre three weekly paclitaxel or 8mg IV pre weekly paclitaxel plus other antiemetics Paclitaxel albumin Breast 2 (Abraxane ) Paclitaxel / Carboplatin Gynaecology / Lung 3 Dexamethasone 20mg IV pre three weekly paclitaxel or 8mg IV pre weekly paclitaxel plus other antiemetics Paclitaxel / Cisplatin Urology (bladder) Pazopanib Renal / Hepatobiliary 1 PCV CNS 1 Pemetrexed / Lung / Carboplatin Mesothelioma Pemetrexed / Cisplatin Lung / Mesothelioma 2 Dexamethasone 4mg PO BD for 3 days starting day before pemetrexed + other antiemetics 4 Dexamethasone 4mg PO BD for 3 days starting day before pemetrexed + other antiemetics Pentostatin Haemato-onc 1 (Deoxycoformycin) PMB Gynaecology 4 PMitCEBO Haemato-onc 3 MitCE week only. No dexamethasone as antiemetic. PMitCEBO Haemato-onc 1 BO week only POMB Germ cell 4 Procarbazine Haemato-onc 4 R Raltitrexed Lower GI 2 R-CHOP Haemato-onc 3 No dexamethasone as antiemetic R-CVP Haemato-onc 3 No dexamethasone as antiemetic R-ESHAP Haemato-onc 4 No dexamethasone as antiemetic
13 R-FC Haemato-onc 3 Rituximab Haemato-onc 1 R-IVE Haemato-onc 3 R-MiniBEAM Haemato-onc 3 Day 1 & 6 only R-MiniBEAM Haemato-onc 2 Day 2 5 only Romidepsin Haemato-onc 3 R-PMitCEBO Haemato-onc 3 MitCE week only. No dexamethasone as antiemetic. R-PMitCEBO Haemato-onc 1 BO week only S Sorafenib Renal / 1 Hepatobiliary Stanford V Haemato-onc 3 Week 1, 3, 5, 7, 9, 11 only. No dexamethasone as antiemetic. Stanford V Haemato-onc 1 Week 2, 4, 6, 8, 10, 12 only Streptozocin / Neuroendocrine 4 Capecitabine Streptozocin / 5FU Neuroendocrine 4 Sunitinib Renal / GIST 1 T Tegafur Lower GI 1 Temozolamide CNS 1 Temsirolimus Renal 1 Thalidomide Haemato-onc 1 Thioguanine Haemato-onc 1 TIP Germ cell 5 Dexamethasone 20mg IV pre 3 weekly paclitaxel (instead of 8mg) plus other antiemetics as per section Topotecan (IV) Gynaecology 2 Topotecan (oral) Lung 2 Trabectedin Sarcoma 4 Trabectedin / Gynaecology 4 Liposomal Doxorubicin Trastuzumab Breast 1 Trastuzumab / Upper GI 5 Cisplatin / Capecitabine Trastuzumab / Upper GI 5 Cisplatin / 5FU Trastuzumab/ Docetaxel Trastuzumab/ Paclitaxel Trastuzumab/ Vinorelbine U UK ALL XI Induction Phase 1 UK ALL XI Induction Phase 2, Day 1, 15, 29 Breast 2 Dexamethasone 8mg PO BD for 3 days starting day before docetaxel + metoclopramide as per section Breast 2 Dexamethasone 20mg IV pre 3 weekly paclitaxel (instead of 8mg) plus other antiemetics as per section Breast 1 Haemato-onc 3 No dexamethasone as antiemetic Haemato-onc 3 No dexamethasone as antiemetic
14 UK ALL XI Induction Haemato-onc 2 No dexamethasone as antiemetic Phase 2 Day 8, 22 UK ALL XI Haemato-onc 3 No dexamethasone as antiemetic Intensification high dose MTX UK ALL XI Haemato-onc 2 No dexamethasone as antiemetic Consolidation Cycle 1, 2, 4 UK ALL XI Haemato-onc 3 No dexamethasone as antiemetic Consolidation Cycle 3 Day 1, 8, 15, 22, 29 V VAD Haemato-onc 3 No dexamethasone as antiemetic VAMP Haemato-onc 3 No dexamethasone as antiemetic VAPEC-B - Week 1 Haemato-onc 3 No dexamethasone as antiemetic & 3 only. VAPEC-B Week 2 & Haemato-onc 1 No dexamethasone as antiemetic 4 only VeIP Urology 3 Vemurafenib Melanoma 1 Vinblastine Various 1 Vincristine Various 1 Vinflunine Urology (bladder) 1 Vinorelbine Breast / lung 1 Includes IV/PO vinorelbine Vinorelbine/ Lung 3 Includes IV/PO vinorelbine Carboplatin Vinorelbine/ Lung 4 Includes IV/PO vinorelbine Cisplatin VIP Germ cell 5 Z Z-DEX Haemato-onc 3 No dexamethasone as antiemetic
15 2.6 Antiemetic Regimen Selection The appropriate antiemetic regimen for the Regimen category designated in the table in section 2.5 should be selected as follows: Level Risk Pre-Chemotherapy Post-Chemotherapy 1 <10% No prophylaxis needed Observation or domperidone or metoclopramide 10-20mg QDS PRN 2 Low 10-30% 3 Mod-high 31-90% 4 High >91% IV dexamethasone 8mg ondansetron 8mg IV plus dexamethasone 8mg IV ondansetron 8 mg IV plus dexamethasone 8mg IV Domperidone or metoclopramide 10mg- 20mg QDS days 1-5 PRN Oral dexamethasone 4 mg BD 2-3 days +/- Oral ondansetron 8mg BD for 2 days plus domperidone or metoclopramide 10-20mg QDS prn Oral dexamethasone 4 mg BD 3-4 days plus Oral ondansetron 8mg BD for 3-4 days plus domperidone or metoclopramide 10-20mg QDS prn NB: If a patient does not have an adequate response to the above regimens then the dose of ondansetron may be escalated to 16mg per dose or aprepitant should be considered according to Trust policy/availability. Where patients meet the following clinical criteria then palonosetron may be substituted for ondansetron: Dysphagia Diabetes (where dexamethasone contraindicated). 5 Highly Aprepitant 125mg PO Emetic or (plus level 4 antiemetics) Grade 3-4 CTC N and V 80mg od for 2 days after chemotherapy (plus level 4 antiemetics) 2.7 Anticipatory nausea and vomiting Prescribe lorazepam 1-2mg orally/sublingually at least 1 hour prior to chemotherapy, in addition to standard antiemetics. If severe, consider 1mg night before chemotherapy and 1mg on the morning of chemotherapy.
16 3.0 Management of Antiemetic Failure and Escalation Policy 3.1 Definition of Antiemetic Failure Antiemetic failure is defined as two or more episodes of vomiting or prolonged/distressing nausea occurring within 24 hours after chemotherapy treatment despite being treated with antiemetics. All patients should be asked about their response to previous antiemetic treatment, where appropriate, and prior antiemetic failure before each course of chemotherapy. Clinicians should ensure that the patient has taken post chemotherapy drugs regularly as prescribed. There are three significant categories: Acute nausea and vomiting which occurs within 24 hours of chemotherapy. Occurs with most cytotoxic agents to some extent. Delayed nausea and vomiting which occurs later than 24 hours after chemotherapy. Cisplatin, carboplatin, cyclophosphamide and the anthracyclines are known to cause delayed emesis. Anticipatory nausea and vomiting which occurs days or hours before chemotherapy. 3.2 Management of Antiemetic Failure If there is no nausea or vomiting, continue on existing anti-emetic regimen. If breakthrough treatment is required, give an additional agent that is from a different drug class prn, e.g.: Prochlorperazine 5-10mg po every 4 to 6 hours or 3-6mg buccally b.d. OR Metoclopramide 10-40mg po/iv every 4 to 6 hours OR Lorazepam 0.5-2mg po/iv/sublingual every 4 to 6 hours OR Levomepromazine 6.25mg 12.5mg od - tds po/sc (12.5mg po = 6.25mg sc) OR Haloperidol 1-2 mg po every 4 to 6 hours OR Nabilone 1-2 mg po bd OR dexamethasone if not previously given (or extend the course if delayed nausea and vomiting) Consider adding lorazepam before and after chemotherapy for anti-emetic failure within the first 24 hours and for longer if nausea persists once ondansetron course has finished. Do not extend the length of treatment of ondansetron. If nausea and vomiting is controlled with breakthrough anti-emetic regimen, then continue the breakthrough medication on a regular basis. If nausea and vomiting not controlled with breakthrough medication, move up to a higher level prophylactic anti-emetic regimen. Dexamethasone is the most useful agent for delayed nausea and vomiting. Dexamethasone schedule for delayed phase can be administered on a reducing dose e.g. 4mg bd for 1 day, 4mg od for 1 day 2mg od for 2 days to minimise dexamethasone side effects. Lorazepam causes amnesia and sedation, and is best for anxious patients or for anticipatory nausea and vomiting. To ensure absorption in vomiting patients, consider route of administration of antiemetics e.g. subcutaneous, intravenous, rectal, buccal, sublingual (Do NOT use suppositories in neutropenic patients) Ensure anti-emetics cover the full period of nausea and vomiting. Consider addition of antacids or proton pump inhibitors for patients sensitive to dexamethasone. Patients should be told to contact the ward if they start vomiting at home. Delayed vomiting may cause acute renal failure due to dehydration exacerbating the nephrotoxicity of chemotherapy.
17 If the patient has failed a level 4 regimen then the following options should be explored: Level Option Pre-Chemotherapy Post-Chemotherapy 4a Maintain dose of Ondansetron and add additional agents Ondansetron 8 mg IV plus Dexamethasone 8mg IV Oral dexamethasone 4 mg BD on days 1 to 4 plus Oral Ondansetron 8mg BD for 4 days post chemo. Plus 4b 4c Escalate dose of Ondansetron Replace Ondansetron with Palonosetron Ondansetron 12 mg IV plus Dexamethasone 8mg IV Replace I.V and oral Ondansetron with Palonosetron I.V. 250 micrograms 4d Add aprepitant 125mg PO prior to chemotherapy 80mg od for 2 days after chemotherapy 4.0 Radiation Induced Nausea and Vomiting 4.1 Principles of Management As for chemotherapy-induced nausea and vomiting, the goal of antiemetic therapy is to prevent nausea and vomiting. The risk of radiation induced emesis varies with the treatment administered. 4.2 Determinants of Emetic Risk The determinants of emetic risk in relation to radiotherapy are as follows: The actual treatment field The dose of radiotherapy administered per fraction The pattern of fractionation 4.3 ChemoRadiation For patients receiving chemoradiation schedules, treat with antiemetic therapy according to the highest emetogenic risk based on the chemotherapy regimen or the radiotherapy treatment field.
18 4.4 Guidance Risk Level Irradiated Area Minimal Extremities Low Breast Head and neck Cranium Lower thorax region Pelvis Pre-radiotherapy Rescue with domperidone or ondansetron Prophylactic or rescue ondansetron Prophylactic Prophylactic antiemetics should continue throughout radiation treatment if patient experiences RINV while receiving therapy For patients who experience RINV while receiving rescue therapy only, prophylactic treatment should continue until radiotherapy is complete Patients should receive antiemetic prophylaxis according to the emetogenicity of concurrent chemotherapy, unless the emetic Cranospinal Moderate Upper abdomen Hemibody irradiation Upper abdomen, abdominalpelvic, mantle, craniospinal irradiation, and cranial radiosurgery Ondasetron (before each fraction for the entire course of radiotherapy) +/- a short course of dexamethasone during fractions 1 to 5 risk with the planned radiotherapy is higher High Total body irradiation (TBI) Total nodal irradiation Ondansteron (before each fraction and for at least 24 hours after completion of radiotherapy) Plus 5 day course of dexamethasone during fractions 1 to 5.
19 5.0 Adverse Drug Reactions associated with commonly-used Antiemetics 5.1 5HT 3 receptor antagonists cause constipation and headache, which can exacerbate nausea. Patients need to be advised accordingly, e.g. lactulose to relieve constipation and paracetamol to relieve headache. If constipation is a problem then alternative treatment options are cyclizine 50mg three times a day or domperidone 20mg four times a day. Laxatives may also be prescribed fluid intake should be encouraged if possible. 5.2 Metoclopramide can rarely cause agitation or the development of extra-pyramidal symptoms particularly in the young female patients. These can occur up to 24 hours after a dose and may vary from facial grimacing and dystonic movements to odd feelings in the mouth, restlessness, somnolence and irritability. Bowel transit time may be reduced and some patients experience diarrhoea. 5.3 Domperidone and metoclopromide should not be used when stimulation of the gastric motility could be harmful. Avoid in gastro-intestinal haemorrhage, mechanical obstruction or perforation. 5.4 Levomepromazine inhibits cytochrome P-450. Common side effects are somnolence, asthenia, dry mouth, hypotension, photosensitivity and skin reactions. Avoid in patients with liver dysfunction. 5.5 Lorazepam can cause drowsiness and may affect performance of skilled tasks (driving) 5.6 Prochlorperazine may cause drownsiness. A mild leukopenia occurs in up to 30% of patients on prolonged high dosage. Avoid in patients with liver or renal dysfunction, Parkinson's disease, hypothyroidism, cardiac failure, phaeochromocytoma, myasthenia gravis, prostatic hypertrophy. 5.7 Dexamethasone can cause sleep disturbances, hyperactivity and excessive appetite. They also impaired glucose tolerance. Patients may experience perineal discomfort if the drug is given by I/V bolus. This can be avoided by administration via IV infusion. Use with care in patients with diabetes mellitus. 5.8 Cyclizine may cause antimuscarinic side effects such as dryness of the mouth and drowsiness. Children and the elderly are more susceptible to these effects. 5.9 Aprepitant common ADRs include headaches, hiccups and fatigue. When given in combinations with corticosteroids, the SPC suggests that the oral dexamethasone dose is reduced by 50%, methylprednisolone IV dose is reduced by 25% and the oral dose by 50%. NB for practical reasons it is not necessary to halve post chemotherapy dexamethasone doses as per the aprepitant trial data.
20 6.0 Appendices 6.1 Action of Antiemetics on Main Receptor Sites Drug D 2 antagonist H 1 antagonist Muscarinic antagonist 5HT 2 antagonist 5HT 3 antagonist 5HT 4 agonist NK1 inhibitor CB ago Metoclopramide Domperidone Cyclizine Hyoscine Haloperidol Levomepromazine Aprepitant Ondansetron Granisetron Lorazepam Nabilone Prochlorperazine / Pharmacological activity 0=none or insignificant, + = slight, ++ = moderate, +++ = marked Table adapted from Twycross R, Wilcock A, - Palliative Care Formulary Forth Edition (2011)
21 7.0 References 1. Jordan, K. et al. Oncologist 2007;12: Hesketh P.J Chemotherapy Induced Nausea and Vomiting (Review Article) N England Journal Med 2008; 358: Hesketh et al. Proposal for Classifying the Acute Emetogenicity of Cancer Chemotherapy. J Clin Oncology (1): Guideline update for MASCC and ESMO in the prevention of chemotherapy and tradiotherapy induced nausea and vomiting : results of the Perugia consensus conference Annals of Oncology 2010: 21(supplement 5) v 232-v Aapro et al. A phase III double blind, randomised trial of Palonosetron compared with ondansetron in preventing chemotherapy induced nausea and vomiting following highly emetogenic chemotherapy Annals of Oncology : Husband A, Worsley A, Nausea and Vomiting pharmacological management Hospital Pharmacist 2007; 14: Cancer Therapy Evaluation Program. Common Terminology Criteria for Adverse Events, Version 4.0. Bethesda, Md: National Cancer Institute, Division of Cancer Treatment and Diagnosis, Navari R M. Pharmacological management of chemotherapy-induced nausea and vomiting. Focus on recent developments. Drugs 2009; 69 (5): National Comprehensive Cancer Network: Antiemesis. NCCN Clinical Practice Guidelines in Oncology v Available at Accessed 29 October Basch et al ASCO guidelines Antiemetics : American Society of Clinical Oncology Clinical Practice Guideline Update Acknowledgements 8.1 King s Lynn Antiemetic Guideline 8.2 Mount Vernon Antiemetic Guideline 8.3 Surrey, West Sussex and Hampshire Cancer Network. Guidelines for the Use of Antiemetics with Chemotherapy. June Accessed via swshcn.nhs.uk. 8.4 Thames Valley Cancer Network. Antiemetic guidelines for the prophylaxis of Chemotherapy and Radiotherapy induced nausea and vomiting in adults (for use by Haematologists and Oncologists). September Accessed via tvcn.nhs.uk. 8.5 Debbie Morrison Cambridgeshire PCT - Author of the initial working draft of this Guideline
Antiemetic Guidelines. Guidelines for the Management of Nausea and Vomiting in Adult Patients Receiving Chemotherapy and/or Radiotherapy
Antiemetic Guidelines Guidelines for the Management of Nausea and Vomiting in Adult Patients Receiving Chemotherapy and/or Radiotherapy For approvals and version control see Document Management Record
More informationGuidelines for the Use of Anti-Emetics with Chemotherapy
Guidelines for the Use of Anti-Emetics with The purpose of this document is to provide guidance on the rational use of anti-emetics for prevention and treatment of chemotherapy-induced nausea and vomiting
More informationWest of Scotland Cancer Network Guideline for Managing Chemotherapy Induced Nausea and Vomiting
West of Scotland Cancer Network Guideline for Managing Chemotherapy Induced Nausea and Vomiting Definitions Acute nausea and vomiting Delayed nausea and vomiting Anticipatory nausea and vomiting Initial
More informationTrust Guideline for Prevention and Control of Chemotherapy and Radiotherapy Induced Nausea and Vomiting in Adults
A Clinical Guideline For Use in: Organisation-wide By: For: Key words: Name of document author: Job title of document author: Name of document author s Line Manager: Job title of author s Line Manager:
More informationGuidelines on Chemotherapy-induced Nausea and Vomiting in Pediatric Cancer Patients
Guidelines on Chemotherapy-induced Nausea Vomiting in Pediatric Cancer Patients COG Supportive Care Endorsed Guidelines Click here to see all the COG Supportive Care Endorsed Guidelines. DISCLAIMER For
More informationGUIDELINES FOR ANTIEMETIC USE IN ONCOLOGY SUMMARY CLASSIFICATION
GUIDELINES FOR ANTIEMETIC USE IN ONCOLOGY SUMMARY More than half of all cancer patients experience nausea or vomiting during the course of their treatment. If nausea or vomiting becomes severe enough,
More informationMASCC Guidelines for Antiemetic control: An update
MASCC / ISOO 17 th International Symposium Supportive Care in Cancer June 30 July 2, 2005 / Geneva, Switzerland MASCC Guidelines for Antiemetic control: An update Sussanne Börjeson, RN, PhD Linköping University,
More informationJob title: Consultant Pharmacist/Advanced Practice Pharmacist
Title : Guidelines for the Use of Antiemetics Purpose: To provide trust-wide guidance on the safe and effective use of antiemetics for the prevention and treatment of chemotherapy and radiotherapy induced
More informationEmetogenicity level 1. Emetogenicity level 2
Emetogenicity level 1 15 mins Pre-Chemo Maxalon 10mg po During chemo and Post Chemo 3 days Maxalon10mg po 8 hourly Increase Maxalon 20mg po 8 hourly Change to Cyclizine 50mg po 8 hourly 3 days If nausea
More informationChemotherapy Induced Nausea and Vomiting (CINV) Anti-emetic Guidelines
North of England Cancer Network Chemotherapy Induced Nausea and Vomiting (CINV) Anti-emetic Guidelines Adult Oncology & Haematology Quality and safety for every patient every time For more information
More informationGuideline Update on Antiemetics
Guideline Update on Antiemetics Clinical Practice Guideline Special Announcements Please check www.asco.org/guidelines/antiemetics for current FDA alert(s) and safety announcement(s) on antiemetics 2 Introduction
More informationNorthern Cancer Alliance
Northern Cancer Alliance Anti-emetic Guidelines for Chemotherapy Induced Nausea and Vomiting (CINV) Adult Oncology & Haematology Document Control Document Title: Antiemetic Guidelines for CINV NESCN v2.2
More informationECN Protocol Book. Antiemetic Guidelines for Adult Patients Receiving Chemotherapy and Radiotherapy
ECN Protocol Book Antiemetic Guidelines f Adult Patients Receiving Chemotherapy and Radiotherapy Name of person presenting document: Reason f document development: Names of development team: Specify groups
More informationSCI. SickKids-Caribbean Initiative Enhancing Capacity for Care in Paediatric Cancer and Blood Disorders
1.0 Introduction The (SCI) is a not-for-profit collaboration between the Hospital for Sick Children (SickKids), Toronto, Canada, and seven Caribbean health care institutions across six countries that strive
More informationPrevention and Management of chemo-and radiotherapy-induced nausea and vomiting
Prevention and Management of chemo-and radiotherapy-induced nausea and vomiting Focusing on the updated MASCC/ESMO guidelines Karin Jordan Department of Hematology and Oncology, University of Heidelberg
More informationMEDICAL NECESSITY GUIDELINE
PAGE: 1 of 10 IMPORTANT REMINDER This Clinical Policy has been developed by appropriately experienced and licensed health care professionals based on a thorough review and consideration of generally accepted
More informationHaematology, Oncology and Palliative Care Directorate.
Anticancer Treatment for Administration on the Somerset Mobile Chemotherapy Unit The table below details the suitability of different types of anticancer treatment for administration on the Somerset Mobile
More informationSystemic Anti-cancer Therapy Care Pathway Guidelines for the management of SACT induced nausea and vomiting in adult patients
Systemic Anti-cancer Therapy Care Pathway Guidelines for the management of SACT induced nausea and vomiting in adult patients Pathway of Care Kent & Medway Cancer Collaborative Publication date June 2018
More informationProtocol Number Tumour Group Protocol Name on NCCP website 22/02/ Lung Afatinib Monotherapy 244 Gastrointestinal Regorafenib Monotherapy
Last Updated 22-Feb-18 Date of last update Protocol Number Tumour Group Protocol Name on NCCP website 22/02/2018 221 Afatinib Monotherapy 244 Gastrointestinal Regorafenib Monotherapy 249 Gynaecology Intrathecal
More informationProtocol Number Intrathecal Methotrexate for CNS 01/02/2018 Prophylaxis in GTN Gynaecology 249
Last updated Feb 9, 2018 Revision due Protocol Name on NCCP website Tumour Group Protocol Number Intrathecal Methotrexate for CNS 01/02/2018 Prophylaxis in GTN Gynaecology 249 Two Day Etoposide CISplatin
More informationAPPHON/ROPPHA Guideline for the Prevention and Management of Chemotherapy Induced Nausea and Vomiting in Children with Cancer
APPHON/ROPPHA Guideline for the Prevention and Management of Chemotherapy Induced Nausea and Vomiting in Children with Cancer 5850/5980 University Avenue, PO Box 9700, Halifax, N.S. B3K 6R8 PEDIATRIC HEMATOLOGY/ONCOLOGY
More informationPrevention and Management of cancer disease and of chemo-and radiotherapyinduced nausea and vomiting
Prevention and Management of cancer disease and of chemo-and radiotherapyinduced nausea and vomiting Focusing on the updated MASCC/ESMO guidelines Karin Jordan Department of Hematology and Oncology, University
More informationWorking Formulary January 2013 Oncology Chemotherapy Regimens
Working Formulary January 2013 Oncology Chemotherapy Regimens In the currently changing commissioning landscape, this document is intended to represent the up to date list of non clinical trial chemotherapy
More informationDOXOrubicin, Cyclophosphamide (AC 60/600) 21 day followed by weekly PACLitaxel (80) Therapy (AC-T) 261 CARBOplatin (AUC4-6) Monotherapy-21 days
Last updated Oct 17, 2018 Tumour Group Protocol Number Protocol Name on NCCP website Breast 200 Trastuzumab (IV) Monotherapy 21 days 201 Trastuzumab (IV) Monotherapy 7 days 202 DOCEtaxel Monotherapy 100mg/m2
More informationSubject: Palonosetron Hydrochloride (Aloxi )
09-J0000-87 Original Effective Date: 02/15/09 Reviewed: 07/09/14 Revised: 03/15/18 Subject: Palonosetron Hydrochloride (Aloxi ) THIS MEDICAL COVERAGE GUIDELINE IS NOT AN AUTHORIZATION, CERTIFICATION, EXPLANATION
More informationCurrent and Emerging Therapeutic Options in the Management of Chemotherapy-Induced Nausea and Vomiting (CINV) Objectives
Current and Emerging Therapeutic Options in the Management of Chemotherapy-Induced Nausea and Vomiting (CINV) Susan Urba, M.D. University of Michigan Comprehensive Cancer Center Objectives Mechanisms of
More informationVI.2 Elements for a Public Summary VI.2.1 Overview of Disease Epidemiology Acute Nausea and Vomiting (N&V) Etiologies:
VI.2 Elements for a Public Summary VI.2.1 Overview of Disease Epidemiology Acute Nausea and Vomiting (N&V) Incidence: The incidence of acute and delayed N&V was investigated in highly and moderately emetogenic
More informationClinical Tools and Resources for Self-Study and Patient Education
Clinical Tools and Resources for Self-Study and Patient Education CHEMOTHERAPY-INDUCED NAUSEA AND VOMITING CLINICIAN'S RESOURCE GUIDE The clinical tools and resources contained herein are provided as educational
More informationSubject: Fosnetupitant-Palonosetron (Akynzeo) IV
09-J3000-01 Original Effective Date: 06/15/18 Reviewed: 05/09/18 Revised: 01/01/19 Subject: Fosnetupitant-Palonosetron (Akynzeo) IV THIS MEDICAL COVERAGE GUIDELINE IS NOT AN AUTHORIZATION, CERTIFICATION,
More informationManagements of Chemotherpay Induded Nausea and Vomiting
REVIEW ARTICLE Managements of Chemotherpay Induded Nausea and Vomiting Department of Surgery, The Catholic University of Korea Sung Geun Kim 23 24 Sung Geun Kim Korean Journal of Clinical Oncology Summer
More informationDescription The following are synthetic cannabinoids requiring prior authorization: dronabinol (Marinol, Syndros ), nabilone (Cesamet )
Clinical Policy: Nabilone (Cesamet), Dronabinol (Marinol, Syndros) Reference Number: CP.CPA.242 Effective Date: 11.16.16 Last Review Date: 11.17 Line of Business: Commercial Revision Log See Important
More informationANTIEMETIC GUIDELINES: MASCC/ESMO
Open Issues for CINV Do we reliably measure that? Do we control nausea optimally? Are guidelines useful for oral therapies related nausea and vomiting? Breakthrough and refractory nausea and vomiting:
More informationSupportive care session 1:
Board review in oncology pharmacy 2013 Managing Disease or Treatment Related Complication Supportive care session 1: Chemotherapy induced-nausea and vomiting Suthan Chanthawong, B. Pharm, RPh. Objectives
More informationGuideline for Classification of the Acute Emetogenic Potential of Antineoplastic Medication in Pediatric Cancer Patients
Guideline for Classification of the Acute Emetogenic Potential of Antineoplastic Medication in Pediatric Cancer Patients POGO Antineoplastic Induced Nausea and Vomiting Guideline Development Panel: L.
More informationCLINICAL GUIDANCE FOR THE PREVENTION AND MANAGEMENT OF CHEMOTHERAPY AND RADIOTHERAPY INDUCED NAUSEA AND VOMITING IN ADULTS
CLINICAL GUIDANCE FOR THE PREVENTION AND MANAGEMENT OF CHEMOTHERAPY AND RADIOTHERAPY INDUCED NAUSEA AND VOMITING IN ADULTS Procedure reference: Document owner: 2196 Version: V2.1 Robert Duncombe, The Director
More informationAntiemetics in chemotherapy
Antiemetics in chemotherapy Title of Guideline (must include the word Guideline (not protocol, policy, procedure etc) Contact Name and Job Title (author) Directorate & Speciality Date of submission Date
More informationSubject: NK-1 receptor antagonist injectable therapy (Emend, Cinvanti, Varubi )
09-J2000-60 Original Effective Date: 06/15/16 Reviewed: 04/11/18 Revised: 01/01/19 Subject: NK-1 receptor antagonist injectable therapy (Emend, Cinvanti, Varubi ) THIS MEDICAL COVERAGE GUIDELINE IS NOT
More informationSee Important Reminder at the end of this policy for important regulatory and legal information.
Clinical Policy: Reference Number: CP.CPA.223 Effective Date: 11.16.16 Last Review Date: 11.17 Line of Business: Commercial Revision Log See Important Reminder at the end of this policy for important regulatory
More informationExhibit B United States Patent Application 20020012663 Kind Code A1 Waksal, Harlan W. January 31, 2002 Treatment of refractory human tumors with epidermal growth factor receptor antagonists Abstract A
More informationAntiemetics: Guidelines, Interactions and more.
Antiemetics: Guidelines, Interactions and more. Chemotherapy-induced side effects -the patient s view Loss of hair The thought of coming for chemo Affects family/partner Affects work/home duties Jude Lees
More informationStandard Regimens for Haematology
Regimens for Haematology ChlVPP Chlorambucil 6mg/m 2 PO D1 to 14 Vinblastine 6mg/m 2 (max 10mg) IV on D1 & 8 Procarbazine 100mg/m 2 PO on D1 to 14 Prednisolone 40mg PO D1 to 14 ABVD Doxorubicin 25mg/m
More informationClinical Policy: Dolasetron (Anzemet) Reference Number: ERX.NPA.83 Effective Date:
Clinical Policy: (Anzemet) Reference Number: ERX.NPA.83 Effective Date: 09.01.18 Last Review Date: 08.18 Revision Log See Important Reminder at the end of this policy for important regulatory and legal
More informationSee Important Reminder at the end of this policy for important regulatory and legal information.
Clinical Policy: (Zofran, Zuplenz) Reference Number: CP.CPA.173 Effective Date: 11.16.16 Last Review Date: 11.17 Line of Business: Medicaid Medi-Cal Revision Log See Important Reminder at the end of this
More informationUpdates in Chemotherapy-Induced Nausea and Vomiting (CINV) 2017
Updates in Chemotherapy-Induced Nausea and Vomiting (CINV) 2017 MELISSA C. MACKEY, PHARMD, BCPS, BCOP ONCOLOGY CLINICAL PHARMACIST DUKE UNIVERSITY HOSPITAL AUGUST 5, 2017 Objectives Review risk factors
More informationCorporate Medical Policy
Antiemetic Injection Therapy Corporate Medical Policy File Name: Origination: Last CAP Review: Next CAP Review: Last Review: antiemetic_injection_therapy 5/2015 3/2017 3/2018 3/2017 Description of Procedure
More informationCommittee Approval Date: December 12, 2014 Next Review Date: July 2015
Medication Policy Manual Policy No: dru378 Topic: Akynzeo, netupitant/palonosetron Date of Origin: December 12, 2014 Committee Approval Date: December 12, 2014 Next Review Date: July 2015 Effective Date:
More informationClinical Policy: Nabilone (Cesamet) Reference Number: ERX.NPA.35 Effective Date:
Clinical Policy: (Cesamet) Reference Number: ERX.NPA.35 Effective Date: 09.01.17 Last Review Date: 08.18 Revision Log See Important Reminder at the end of this policy for important regulatory and legal
More informationManaging Adverse Events in the Cancer Patient. Learning Objectives. Chemotherapy-Induced Nausea/Vomiting
Managing Adverse Events in the Cancer Patient Lisa A Thompson, PharmD, BCOP Assistant Professor University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences Learning Objectives Describe
More informationAnti-Emetic Guidelines for Adults Receiving Chemotherapy
Anti-Emetic Guidelines for Adults Receiving Chemotherapy Version 2 Date of Publication: February 2007 Updated February Original Author(s): Sue Robinson Lead Pharmacist Arden Cancer Network Edited & adapted
More informationGUIDELINE FOR THE MANAGEMENT OF CHEMOTHERAPY-INDUCED NAUSEA AND VOMITING.
Page 1 of 20 Guideline for the management of chemotherapy-induced nausea and vomiting, v2.1.1 GUIDELINE FOR THE MANAGEMENT OF CHEMOTHERAPY-INDUCED NAUSEA AND VOMITING. Version: 2.1.0 Ratified by: Date
More informationDefining the Emetogenicity of Cancer Chemotherapy Regimens: Relevance to Clinical Practice
Defining the Emetogenicity of Cancer Chemotherapy Regimens: Relevance to Clinical Practice PAUL J. HESKETH St. Elizabeth s Medical Center, Boston, Massachusetts, USA Key Words. Chemotherapy Emesis Emetogenicity
More informationAntiemesis. NCCN Clinical Practice Guidelines in Oncology. Antiemesis. Version Continue
Table of Contents Clinical in Oncology Version 2.2010 Continue www.nccn.org Version 2.2010, 04/07/2010 2010 National Comprehensive Cancer Network, Inc. All rights reserved. These guidelines and this illustration
More informationChemotherapy induced emesis: Are we doing are best? David Warr University of Toronto
Chemotherapy induced emesis: Are we doing are best? David Warr University of Toronto david.warr@uhn.on.ca Conflict of interest Merck: speakers bureau and consultant Eisai: consultant Outline What is the
More informationThames Valley. Grading of Nausea and Vomiting 1,5
Anti-emetic guidelines for the prophylaxis of Chemotherapy and Radiotherapy induced nausea and vomiting in ADULTS (for use by Haematologists and Oncologists) Introduction Chemotherapy Induced Nausea and
More informationCLINICAL GUIDELINE FOR ANTIEMETIC USE IN PAEDIATRIC ONCOLOGY 1. Aim/Purpose of this Guideline
CLINICAL GUIDELINE FOR ANTIEMETIC USE IN PAEDIATRIC ONCOLOGY 1. Aim/Purpose of this Guideline 1.1. This guideline applies to medical and nursing staff working with paediatric oncology patients. 2. The
More informationClinical Policy: Ondansetron (Zuplenz) Reference Number: CP.PMN.45 Effective Date: Last Review Date: Line of Business: Medicaid
Clinical Policy: (Zuplenz) Reference Number: CP.PMN.45 Effective Date: 09.01.06 Last Review Date: 02.19 Line of Business: Medicaid Revision Log See Important Reminder at the end of this policy for important
More informationTo help doctors give their patients the best possible care, the American
Patient Information Resources from ASCO What to Know ASCO s Guideline on Preventing Vomiting Caused by Cancer Treatment SEPTEMBER 2011 KEY MESSAGES The risk of nausea and vomiting depends on the specific
More informationSee Important Reminder at the end of this policy for important regulatory and legal information.
Clinical Policy: (Anzemet) Reference Number: CP.PMN.141 Effective Date: 09.01.06 Last Review Date: 08.18 Line of Business: Commercial, HIM, Medicaid Revision Log See Important Reminder at the end of this
More informationSee Important Reminder at the end of this policy for important regulatory and legal information.
Clinical Policy: (Cesamet) Reference Number: CP.PMN.160 Effective Date: 11.16.16 Last Review Date: 02.19 Line of Business: Commercial, Medicaid Revision Log See Important Reminder at the end of this policy
More informationUse of Prophylactic Growth Factors and Antimicrobials in Elderly Patients with Cancer: A
Supportive Care in Cancer Use of Prophylactic Growth Factors and Antimicrobials in Elderly Patients with Cancer: A Systematic Review of the Medicare Database Romina Sosa, Shuling Li, Julia T. Molony, Jiannong
More informationUpdate on antiemetics, what is new and future directions. Karin Jordan University of Halle
Update on antiemetics, what is new and future directions Karin Jordan University of Halle History of Antiemetics Controlling Chemotherapy-Induced EMESIS: Progress Over The Past 30 Years: Efficacy 5-Day
More informationCCC Chemotherapy Protocols V9.0
CCC Chemotherapy Protocols V9.0 General observations 3 Breast cancer 5 Gastrointestinal cancer Oesophagus 17 Gastric 19 Pancreas 22 Cholangiocarcinoma 24 Hepatocellular carcinoma 25 Neuroendocrine tumours
More informationANTIEMETICS UTILIZATION MANAGEMENT CRITERIA
ANTIEMETICS [Akynzeo, Anzemet, Cesamet, Emend, Sancuso, Varubi, Zuplenz ] DRUG CLASS: UTILIZATION MANAGEMENT CRITERIA 5-HT 3 Receptor Antagonists 5-HT 3 Receptor Antagonist and Substance P/Neurokinin (NK
More informationPrimary malignant neoplasms, not lymphatic or hematopoietic. Secondary malignant neoplasms (i.e.metastatic) Malignant neoplasm, unknown site
Supplementary Table 1. ICD-9-CM codes used to define cancer ICD-9 Diagnosis code 140.xx-172.xx 174.xx-195.xx 196.xx 198.xx 199.xx 200.xx-208.xx Description Primary malignant neoplasms, not lymphatic or
More informationDRUG EXTRAVASATION. Vesicants. Irritants
DRUG EXTRAVASATION Vesicants Irritants Vesicants Antineoplastic drugs Amsacrine Dactinomycin Daunorubicin Docetaxel (rare) Doxorubicin Epirubicin Idarubicin Mechlorethamine Mitomycin Oxaliplatin (rare)
More informationWe would like to thank you for completing this audit questionnaire which looks at how you manage nausea and vomiting in palliative care patients.
We would like to thank you for completing this audit questionnaire which looks at how you manage nausea and vomiting in palliative care patients. The closing date for responses is 19th December The results
More informationAdverse effects of anticancer drugs (Antimetabolites agents, Alkylating agents, Antimicrotubule agents, Miscellaneous agents, Immune therapies and
35 Adverse effects of anticancer drugs (Antimetabolites agents, Alkylating agents, Antimicrotubule agents, Miscellaneous agents, Immune therapies and Biologically directed therapies ) 1 1- Nausea and vomiting
More informationClinical Policy: Aprepitant (Emend) Reference Number: CP.PMN.19 Effective Date: 11/06 Last Review Date: 08/17
Clinical Policy: (Emend) Reference Number: CP.PMN.19 Effective Date: 11/06 Last Review Date: 08/17 Line of Business: Medicaid Revision Log See Important Reminder at the end of this policy for important
More information1. Purpose Documentation Description.1 4. References 8 5. Cross-References.8 6. Development of the guideline.8
CLINICAL GUIDELINE For use in (clinical areas): For use by (staff groups): For use for (patients): Document owner: Status: Oncology/Haematology Unit (excluding Paediatrics) Oncologists, Haematologists,
More informationAdult Intravenous Systemic Anticancer Therapy (SACT) Section A. SUMMARY of SCHEME QIPP Reference
CA2 Nationally standardised Dose banding for Adult Intravenous Anticancer Therapy (SACT) Scheme Name CA2: Nationally Standardised Dose Banding for Adult Intravenous Systemic Anticancer Therapy (SACT) Section
More informationDrug: Aprepitant (Emend ) Date of Review: 4/01/10
CAMBRIDGESHIRE JOINT PRESCRIBING GROUP Business Case Evaluation and Recommendation Document Drug: Aprepitant (Emend ) Date of Review: 4/01/10 Business Case Decision and date: DOUBLE RED, 20 January 2010
More informationRichard J. Gralla, MD Medical Director Quality of Life Research Associates New York, NY
Oncology Consultations Improving the Management of Chemotherapy-Induced Nausea and Vomiting (CINV) A CE-Certified Activity Featuring Consultations With Supported by an educational grant from Eisai. Dannemiller
More informationReview Article Prevention of Nausea and Vomiting in Patients Undergoing Oral Anticancer Therapies for Solid Tumors
Hindawi Publishing Corporation BioMed Research International Volume 2015, Article ID 309601, 7 pages http://dx.doi.org/10.1155/2015/309601 Review Article Prevention of Nausea and Vomiting in Patients Undergoing
More informationRole of Pharmacist in Supportive care cancer
Role of Pharmacist in Supportive care cancer Manit Sae-teaw B.Pharm, BCOP, BCP Grad. Dip. In Pharmacotherapy Faculty of Pharmaceutical Science Ubon Ratchathani University 1 Outline Cancer facts Supportive
More informationComplications of the Systemic Treatment of Cancer
Complications of the Systemic Treatment of Cancer An Introduction to Acute Oncology July 2015 Aims and Objectives To be aware of the range of systemic therapies used in modern cancer care To list the potential
More informationSee Important Reminder at the end of this policy for important regulatory and legal information.
Clinical Policy: (Kytril, Sancuso, Sustol) Reference Number: CP.PMN.74 Effective Date: 11.01.16 Last Review Date: 02.19 Line of Business: Commercial, Medicaid Coding Implications Revision Log See Important
More informationGastrointestinal Alterations
Gastrointestinal Alterations Nancy Thompson, RN, MS, AOCNS Swedish Cancer Institute Nausea & Vomiting Mucositis Taste Alterations Anorexia / Cachexia GI Alterations The Chinese do not draw any distinction
More informationChemotherapy Induced Nausea and Vomiting
Chemotherapy Induced Nausea and Vomiting Aminah Jatoi, M.D. Professor of Oncology Mayo Clinic Rochester, Minnesota April 27, 2017 clinical and biologic fundamentals of chemotherapy induced nausea and vomiting
More informationICON Formulary - October 2018 Legend - ICON Protocols Essential (previously Standard), Core, Enhanced Core, Enhanced Enhanced
ICON Formulary - October 2018 Legend - ICON Protocols Essential (previously Standard), Core, Enhanced Core, Enhanced Enhanced Class Medicine Name Nappi Strength Form Size Route Abiraterone Acetate ZYTIGA
More informationELECTRONIC HEALTH RECORD (EHR) ENHANCEMENTS FOR MARCH 15, 2016 SUMMARY
ELECTRONIC HEALTH RECORD (EHR) ENHANCEMENTS FOR MARCH 15, 2016 SUMMARY Problem Opening PACS Images on ipads or ibooks has Been Fixed Changes have been made in PROD to enable user credentials to be passed
More informationATTUALITÀ NEL CONTROLLO DELL EMESI
ATTUALITÀ NEL CONTROLLO DELL EMESI Dr Claudio Lotesoriere Dipartimento di Oncoematologia S.C. di Oncologia Medica P.O. San G. Moscati TARANTO email oncologia.taranto@gmail.com Types of CINV: Definitions
More informationAcute Oncology Guidelines (2014) Version 2.0 Network Cancer Leads Group (Incorporating Network Acute Oncology Group & Network Radiotherapy Group)
Acute Oncology Guidelines (2014) Version 2.0 Network Cancer Leads Group (Incorporating Network Acute Oncology Group & Network Radiotherapy Group) Agreed: June 2014 Review Date: June 2015 Contents Page
More informationChemotherapy-Induced Nausea and Vomiting: Strategies for Achieving Optimal Control
Chemotherapy-Induced Nausea and Vomiting Strategies for Achieving Learning Objectives Describe the challenges of assessing nausea in patients undergoing chemotherapy and the impact of nausea and also vomiting
More informationPrevention of chemotherapy induced nausea and vomiting in pediatric cancer patients
REVIEW ARTICLE Prevention of chemotherapy induced nausea and vomiting in pediatric cancer patients Shubham Roy 1, Rashi Kulshrestha 2, Abhishek Shankar 3, Goura Kishor Rath 4, Vipin Kharade 4 1 Department
More informationChemotherapy-induced Nausea and Vomiting: The Pharmacist s Role in Integrating Clinical Guidelines into Patient Care
Chemotherapy-induced Nausea and Vomiting: The Pharmacist s Role in Integrating Clinical Guidelines into Patient Care Presented as a Live Webinar Wednesday, April 13, 2016 12:00 p.m. 1:00 p.m. ET Tuesday,
More informationNausea and Vomiting. Symptom Management of Gastrointestinal Alterations. Gastrointestinal Alterations. Nausea/Vomiting Patterns
Symptom Management of Gastrointestinal Alterations Elise Frans, MN, RN, CWON Oncology Clinical Nurse Specialist University of Washington Medical Center delterzo@uw.edu Nausea and Vomiting Mucositis Taste
More informationNCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines ) Antiemesis. Version NCCN.org. Continue
NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines ) Version 1.2011 NCCN.org Continue Note: All recommendations are category 2A unless otherwise indicated. Clinical Trials: NCCN believes that
More information1 The Cancer Programs Regulation (AR 242/98) is amended by this Regulation.
Alberta Regulation 18/2005 Cancer Programs Act AMENDMENT REGULATION Filed: February 22, 2005 For information only: Made by the Minister of Health and Wellness (M.O. 9/2005) on February 17, 2005 pursuant
More informationComparison of the Control of Nausea and Vomiting among Several Moderately Emetic-Risk Chemotherapy Regimens
569 Ivyspring International Publisher Research Paper Journal of Cancer 2016; 7(5): 569-575. doi: 10.7150/jca.13637 Comparison of the Control of Nausea and Vomiting among Several Moderately Emetic-Risk
More informationPatient-Centered Management of Chemotherapy-Induced Nausea and Vomiting
Clear and accurate communication between patients and health care teams is the key to successfully controlling chemotherapy-induced nausea and vomiting. Roseate Spoonbill_2005. Photograph courtesy of Henry
More informationMOLECULAR AND CLINICAL ONCOLOGY 2: , 2014
MOLECULAR AND CLINICAL ONCOLOGY 2: 375-379, 2014 Palonosetron exhibits higher total control rate compared to first generation serotonin antagonists and improves appetite in delayed phase chemotherapy induced
More informationDelayed emesis: moderately emetogenic chemotherapy (single-day chemotherapy regimens only)
Support Care Cancer (2011) 19 (Suppl 1):S57 S62 DOI 10.1007/s00520-010-1039-y SPECIAL ARTICLE Delayed emesis: moderately emetogenic chemotherapy (single-day chemotherapy regimens only) Fausto Roila & David
More informationOPCS Classification of Interventions and Procedures Version 4.6 (April 2011)
Chemotherapy Regimens Clinical Coding Guidance OPCS-4.6 Version 1.0 Programme Sub Programme Data Standards & Products Clinical Classifications Document Record ID Key NPFIT-SHR-SHI-0318.01 Programme Director
More informationCOST CONSIDERATIONS Union for International Cancer Control 2014 Review of Cancer Medicines on the WHO List of Essential Medicines!!!!!!!!!
UICCEMLCostingScenarios BackoftheEnvelope Calculations PreparedforWorkingGroupSession:19621November2014,Geneva MethodsSummary We have chosen a conservative approach, calculating cost per vial. We have
More informationCHEMOTHERAPY-INDUCED NAUSEA AND VOMITING
CHEMOTHERAPY-INDUCED NAUSEA AND VOMITING Jennifer Shamai MS, RN, AOCNS, BMTCN Professional Practice Leader Department of Clinical Practice And Professional Education Click How to the edit Experts Master
More informationManagement of Chemotherapy Induced Nausea/Vomiting(CINV) in Adult Cancer Patients
Management of Chemotherapy Induced Nausea/Vomiting(CINV) in Adult Cancer Patients By Zahra Shaghaghi, Pharm-D, BCOP, PhC Prepared for 2018 NMSHP Balloon Fiesta Symposium Goals and Objectives: Describe
More informationManagement of Chemotherapy Induced Nausea/Vomiting(CINV) in Adult Cancer Patients
Management of Chemotherapy Induced Nausea/Vomiting(CINV) in Adult Cancer Patients By Zahra Shaghaghi, Pharm-D, BCOP, PhC Prepared for 2018 NMSHP Balloon Fiesta Symposium 1 Goals and Objectives: Describe
More information