Guidelines for Complications of Cancer Treatment Vol VIII Part B

Evidence Based Management GuidelinesThe treatment recommendations that follow reflect a compositeof the consensus recommendations of various randomizedcontrolled trials.Highly Emetogenic ChemotherapyThe three drug regimen mentioned above is now a standard ofcare in highly emetogenic chemotherapy. This regimen whencompared with two-drug regimen (5HT3 antagonist andDexamethasone) in various randomized phase-3 trials hasshown significant reduction in acute (Day 1) emesis i.e. 7-17% vs 19-33% respectively. Various placebo controlledmulticentric phase three trials have also shown aprepitant tohave significant effect on delayed vomiting which translatedinto better quality of life. Schmoll et al demonstrated in theirphase three study that Aprepitant plus Dexamethasone whencompared with 5HT3 antagonist plus Dexamethasone hadsignificant reduction in delayed CINV (21% vs 36%respectively). (Level I, A)Moderate emetogenic therapy (anthracyclines based)Aprepitant when added to 5HT3 antagonist andDexamethasone therapy to prevent emesis in breast cancerpatients on anthracycline based chemotherapy, significantlydecreased day1 to day5 emesis. Heersted et al carried out adouble blind phase three study of 866 patients in whichexperimental arm (i.e. arm managed with three drugs 5HT3+Dexa+ Aprepitant) had significantly less day 1-5 vomitingwhen compared with control arm ( i.e. arm managed with 5HT3+ Dexamethasone). (Level II, A)Moderate emetogenic therapy (non anthracyclinesbased)The recommendation of two-drug regimen (5HT3 antagonistand Dexa) for the prevention of acute emesis in this group is398