Managements of Chemotherpay Induded Nausea and Vomiting
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1 REVIEW ARTICLE Managements of Chemotherpay Induded Nausea and Vomiting Department of Surgery, The Catholic University of Korea Sung Geun Kim 23
2 24 Sung Geun Kim
3 Korean Journal of Clinical Oncology Summer 2012;Vol.8,NO.1: Table 1. Classification of intravenous anticancer drugs based on emetogenic potential Level Agent (intravenous chemotherapy) High emetic risk AC combination defined as either.doxorubicin or epirubicin with cyclophosphamide (> 90 % frequency of emesis) Carmustine > 250 mg/m 2 Cisplatin 50 mg/m 2 Cyclophosphamide > 1,500 mg/m 2 Dacarbazine Mechlorethamine Streptozocin Moderate emetic risk Aldesleukin(IL-2) > 12~15 million Dactinomycin (30-90 % frequency of emesis) units/m 2 Daunorubicin Altretamine Doxorubicin Amifostine > 300 mg/m 2 Epirubicin Arsenic trioxide Idarubicin Azacitidine Ifosfamide Bendamustine Interferon alfa 10 million IU/m 2 Busulfan Irinotecan Carboplatin Melphalan Carmustine 250 mg/m 2 Methotrexate 250 1,000 mg/m 2 Cisplatin < 50 mg/m 2 Oxaliplatin Clofarabine Temozolomide Cyclophosphamide 1,500 mg/m 2 Cytarabine > 200 mg/m 2 Low emetic risk Amifostine 300 mg Ixabepilone (10-30 % frequency of emesis) Aldesleukin(IL-2) 12million units/m 2 Methotrexate > 50 mg/m 2 < 250 mg/m 2 Cytarabine (low dose) mg/m 2 Mitomycin Docetaxel Mitoxantrone Doxorubicin (liposomal) Paclitaxel Etoposide Paclitaxel-albumin 5-fluorouracil Pemetrexed Floxuridine Pentostatin Gemcitabine Romidepsin Interferon alfa > 5million IU/m 2 Topotecan <10million IU/m 2 Minimal emetic risk Alemtuzumab Interferon Alpha 5 million IU/m 2 (< 10 % frequency of emesis) Asparaginase Methotrexate 50mg/m 2 Bevacizumab Nelarabine Bleomycin Panitumumab Bortezomib Pegaspargase Cetuximab Rituximab Cladribine Temsirolimus Cytarabine 100 mg/m 2 Trastuzumab Decitabine Valrubicin Dexrazoxane Vinblastine Denileukin diftitox Vincristine Fludarabine Vinorelbine Gemtuzumab ozogamicin 25
4 Table 2. Classes of antiemetics Drug class Example of drugs 5-HT3 receptor antagonists Ondansetron, granisetron, tropisetron, dolasetron, palonosetron Neurokinin(NK-1) Aprepitant, fosaprepitant, casopitant receptor antagonists Glucocorticoids Dexamethazone, methylprednosolone Dopamine receptor antagonists Phenothiazines(prochlorperazine,metoprimazine) Substituted benzamides(metochlopramide, alizapride) Butyrophnones(droperidol, haloperidol) domperidone Cannabinoids Nabilone, dronabinol Benzodiazepines lorazepam, olanzapine Anticholinergics : scopolamine Antihistamines diphenhydramine 26 Sung Geun Kim
5 Korean Journal of Clinical Oncology Summer 2012;Vol.8,NO.1: Table 3. CINV Emetogenic potential Anti-emetics High Day 1 Day 2 Day 3 Day 4 (> 90% frequency of emesis) aprepitant 125 mg + aprepitant 80 mg + aprepitant 80 mg + corticosteroid serotonin(5-ht3) receptor corticosteroid corticosteroid antagonist+ corticosteroid serotonin(5-ht3) receptor antagonist serotonin(5-ht3) receptor antagonist serotonin(5-ht3) receptor antagonist metoclopramide Moderate (30-90% frequency of emesis) serotonin(5-ht3) receptor antagonist serotonin(5-ht3) receptor antagonist PO.* serotonin(5-ht3) receptor antagonist metoclopramide Day 1 Day 2 Day 3 aprepitant 125mg aprepitant 80 mg aprepitant 80 mg + serotonin(5-ht3) receptor antagonist PO.*+ corticosteroid Low corticosteroid (10-30% frequency of emesis) No routine prophylaxis Minimal No routine prophylaxis (< 10% frequency of emesis) * PO. : per os (oral medication) REFERENCES 1. Lohr L. Chemotherapy-induced nausea and vomiting. Cancer J Mar-Apr;14(2): Feyer P, Jordan K. Update and new trends in antiemetic therapy: the continuing need for novel therapies. Ann Oncol Jan;22(1): Bloechl-Daum B, Deuson RR, Mavros P, Hansen M, Herrstedt J. Delayed Nausea and Vomiting Continue to Reduce Patients Quality of Life After Highly and Moderately Emetogenic Chemotherapy Despite Antiemetic Treatment. Journal of Clinical Oncology September 20, 2006;24(27): de Boer-Dennert M, de Wit R, Schmitz PI, Djontono J, v Beurden V, Stoter G, et al. Patient perceptions of the side-effects of chemotherapy: the influence of 5HT3 antagonists. Br J Cancer. 27
6 1997;76(8): Chabner B, Longo DL. Cancer chemotherapy and biotherapy : principles and practice. 5th ed. ed. Philadelphia, Pa. ; London: Lippincott Williams & Wilkins; Hornby PJ. Central neurocircuitry associated with emesis. Am J Med Dec 3;111 Suppl 8A:106S-12S. 7. Kris MG, Radford JE, Pizzo BA, Inabinet R, Hesketh A, Hesketh PJ. Use of an NK1 receptor antagonist to prevent delayed emesis after cisplatin. J Natl Cancer Inst Jun 4;89(11): NCCN. National Comprehesive Cancer Network: Antiemesis, Clinical Practive Guidelines in Oncology-v wwwnccnorg Balfour JA, Goa KL. Dolasetron. A review of its pharmacology and therapeutic potential in the management of nausea and vomiting induced by chemotherapy, radiotherapy or surgery. Drugs Aug;54(2): Kris MG, Hesketh PJ, Somerfield MR, Feyer P, Clark-Snow R, Koeller JM, et al. American Society of Clinical Oncology guideline for antiemetics in oncology: update J Clin Oncol Jun 20;24(18): Roila F, Herrstedt J, Aapro M, Gralla RJ, Einhorn LH, Ballatori E, et al. Guideline update for MASCC and ESMO in the prevention of chemotherapy- and radiotherapy-induced nausea and vomiting: results of the Perugia consensus conference. Ann Oncol May;21 Suppl 5:v Grunberg SM, Warr D, Gralla RJ, Rapoport BL, Hesketh PJ, Jordan K, et al. Evaluation of new antiemetic agents and definition of antineoplastic agent emetogenicity--state of the art. Support Care Cancer Mar;19 Suppl 1:S Schwartzberg L. Chemotherapy-induced nausea and vomiting: state of the art in J Support Oncol Feb;4(2 Suppl 1): Hesketh PJ. Chemotherapy-induced nausea and vomiting. N Engl J Med Jun 5;358(23): Prevention of chemotherapy- and radiotherapy-induced emesis: results of Perugia Consensus Conference. Antiemetic Subcommittee of the Multinational Association of Supportive Care in Cancer (MASCC). Ann Oncol Aug;9(8): Rojas C, Slusher BS. Pharmacological mechanisms of 5-HT3 and tachykinin NK1 receptor antagonism to prevent chemotherapyinduced nausea and vomiting. European Journal of Pharmacology. 2012(0). 17. Lorusso V, Giampaglia M, Petrucelli L, Saracino V, Perrone T, Gnoni A. Antiemetic efficacy of single-dose palonosetron and dexamethasone in patients receiving multiple cycles of multiple day-based chemotherapy. Support Care Cancer Apr Einhorn LH, Brames MJ, Dreicer R, Nichols CR, Cullen MT, Jr., Bubalo J. Palonosetron plus dexamethasone for prevention of chemotherapy-induced nausea and vomiting in patients receiving multiple-day cisplatin chemotherapy for germ cell cancer. Support Care Cancer Nov;15(11): Hale JJ, Mills SG, MacCoss M, Dorn CP, Finke PE, Budhu RJ, et al. Phosphorylated morpholine acetal human neurokinin-1 receptor antagonists as water-soluble prodrugs. J Med Chem Mar 23;43(6): Grunberg SM. Antiemetic activity of corticosteroids in patients receiving cancer chemotherapy: dosing, efficacy, and tolerability analysis. Ann Oncol Feb;18(2): Vardy J, Chiew KS, Galica J, Pond GR, Tannock IF. Side effects associated with the use of dexamethasone for prophylaxis of delayed emesis after moderately emetogenic chemotherapy. Br J Cancer Apr 10;94(7): service hiraa. antiemesis. 2012: Gao H, Liang Y, Zhou N, Zhang D, Wu H. Aprepitant plus palonosetron and dexamethasone for prevention of chemotherapyinduced nausea and vomiting in patients receiving multiple-day cisplatin-based chemotherapy. Intern Med J Dec Grote T, Hajdenberg J, Cartmell A, Ferguson S, Ginkel A, Charu V. Combination therapy for chemotherapy-induced nausea and vomiting in patients receiving moderately emetogenic chemotherapy: palonosetron, dexamethasone, and aprepitant. J Support Oncol Sep;4(8): Sung Geun Kim
7 Korean Journal of Clinical Oncology Summer 2012;Vol.8,NO.1: Department of Surgery, The Catholic University of Korea Sung Geun Kim, Associate Professor 29
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