This review is an update of the MASCC/ESMO 2015 recommendations for the prophylaxis of acute and delayed nausea and vomiting induced by multiple-day chemotherapy, high-dose chemotherapy, and breakthrough nausea and vomiting.A systematic literature search was conducted using PubMed from June 1, 2015, through February 1, 2023.We identified 56 references (16 were duplications or invalid), leaving 40 manuscripts for this search. The panel classified level I evidence (three manuscripts) and level II evidence (14 manuscripts). High-dose chemotherapy and stem cell transplant were discussed in four of these manuscripts, and multiple-day chemotherapy treatment in 15. Some manuscripts covered both topics. Additionally, a search for breakthrough nausea and vomiting resulted in 12 "hits." No new relevant studies were identified.The recommendations for patients receiving high-dose chemotherapy with stem cell transplants and patients undergoing multiple-day cisplatin were updated. For patients receiving high-dose chemotherapy for stem cell transplant, a combination of a 5-HT3 receptor antagonist with dexamethasone and aprepitant is recommended. Olanzapine could be considered part of the antiemetic regimen. Patients receiving multiple-day cisplatin should receive a 5-HT3 receptor antagonist plus dexamethasone plus aprepitant plus olanzapine. For patients experiencing breakthrough nausea and vomiting, the available evidence suggests using a single dose of olanzapine daily for 3 days. 

2023 updated MASCC/ESMO consensus recommendations: prevention of nausea and vomiting following multiple-day chemotherapy, high-dose chemotherapy, and breakthrough nausea and vomiting

Abstract Purpose Data on the optimal management of patients with hematologic malignancies and chemotherapy-induced nausea and vomiting (CINV) are lacking. We report our institutional experience in patients with B-cell lymphoma receiving multiday dose-adjusted R-EPOCH chemotherapy. Methods We performed a retrospective, single-center, cohort study evaluating hospitalized patients with aggressive non-Hodgkin B-cell lymphoma receiving DA-R-EPOCH (April 2016 to October 2022). All patients received a corticosteroid and 5HT3RA and categorized by the addition of an NK1RA or not. The primary outcome was complete response (CR, no vomiting, and no rescue medication use) over 120 hours. Secondary outcomes included as-needed antiemetic use (acute, delayed, and overall phases), CR without escalating prophylactic antiemetics in cycle 2, and complete control. We performed a descriptive analysis and multivariate logistic regression for NK1RA use, adjusting for age and sex. Results Of 128 patients, 56 (43.8%) received an NK1RA as part of their antiemetic regimen, and 72 (56.3%) did not. No patients received prophylactic olanzapine. CR was achieved in 32 (57.1%) of those who received an NK1RA and 30 (41.7%) who did not (OR 0.45; 95% CI, 0.21–0.96; p = 0.039). We observed trends between groups in as-needed antiemetics use (29 [51.8%] vs. 49 [68.1%]; p = 0.061), with most use in the delayed phase (22 [39.3%] vs. 37 [51.4%], p = 0.173). We found no difference in healthcare utilization between the first and second cycle or in CR with escalation of cycle 2 prophylactic antiemetics. Conclusion CINV control in patients with non-Hodgkin B-cell lymphoma receiving DA-R-EPOCH in the hospital was suboptimal. These data support the need to optimize prophylactic antiemetic regimens for patients receiving DA-R-EPOCH. 

Addition of an NK1 receptor antagonist to standard antiemetic prophylaxis in patients with B-cell lymphoma receiving EPOCH

Prevention of chemotherapy-induced nausea and vomiting (CINV) is particularly challenging for patients receiving highly emetogenic preparative regimens before autologous stem cell transplantation (ASCT) due to the daily and continuous emetogenic stimulus of the multiple day chemotherapy. While studies have shown effective prevention of CINV during the conditioning phase with NK1 receptor antagonist (NK1RA)-containing regimens, there have been no studies evaluating antiemetic use during chemomobilization prior to ASCT. This multicenter, open-label, phase IIa study evaluated the efficacy of every-other-day dosing of NEPA administered during chemomobilization in patients with relapsed-refractory aggressive non-Hodgkin’s lymphoma. Eighty-one patients participated. Response rates were 77.8% for complete response (no emesis and no rescue use), 72.8% for complete control (complete response and no more than mild nausea), 86.4% for no emesis, and 82.7% for no rescue use during the overall phase (duration of chemomobilization through 48 h after). NEPA was well tolerated with no treatment-related adverse events reported. NEPA, administered with a simplified every-other-day schedule, show to be very effective in preventing CINV in patients at high risk of CINV undergoing to chemomobilization of hematopoietic stem cells prior to ASCT.

/pdf/efficacy-and-safety-of-netupitant-palonosetron-combination-4pmi2mt5gb.pdf

Efficacy and safety of netupitant/palonosetron combination (NEPA) in preventing nausea and vomiting in non-Hodgkin's lymphoma patients undergoing to chemomobilization before autologous stem cell transplantation.

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Efficacy and safety of netupitant/palonosetron combination (NEPA) in preventing nausea and vomiting in non-Hodgkin's lymphoma patients undergoing to chemomobilization before autologous stem cell transplantation.