title: Acute emesis: moderately emetogenic chemotherapy.
abstract: This paper is a review of the recommendations for the prophylaxis of acute emesis induced by moderately emetogenic chemotherapy as concluded at the third Perugia Consensus Conference, which took place in June 2009. The review will focus on new studies appearing since the Second consensus conference in April 2004. The following issues will be addressed: dose and schedule of antiemetics, different groups of antiemetics such as corticosteroids, serotonin(3) receptor antagonists, dopamine(2) receptor antagonists, and neurokinin(1) receptor antagonists. Furthermore, antiemetic prophylaxis in patients receiving multiple cycles of moderately emetogenic chemotherapy will be reviewed. Consensus statements are given, including optimal dose and schedule of serotonin(3) receptor antagonists, dexamethasone, and neurokinin(1) receptor antagonists. The most significant recommendations (and changes since the 2004 version of the guidelines) are as follows: the best prophylaxis in patients receiving moderately emetogenic chemotherapy (not including a combination of an anthracycline plus cyclophosphamide) is the combination of palonosetron and dexamethasone on the day of chemotherapy, followed by dexamethasone on days 2-3. In patients receiving a combination of an anthracycline plus cyclophosphamide, a combination of a serotonin(3) receptor antagonist plus dexamethasone, plus the neurokinin(1) receptor antagonist aprepitant on the day of chemotherapy, followed by aprepitant days 2-3, is recommended.
authors.affiliation: Department of Oncology, Odense University Hospital, 5000 Odense, Denmark. herrstedt@dadlnet.dk
authors.forename: Jørn
authors.initials: J
authors.lastname: Herrstedt
authors.forename: Bernardo
authors.initials: B
authors.lastname: Rapoport
authors.forename: David
authors.initials: D
authors.lastname: Warr
authors.forename: Fausto
authors.initials: F
authors.lastname: Roila
authors.forename: Emilio
authors.initials: E
authors.lastname: Bria
authors.forename: Cynthia
authors.initials: C
authors.lastname: Rittenberg
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Hesketh
mesh_terms: D000932:Antiemetics / Q000008:administration & dosage*; D000970:Antineoplastic Agents / Q000009:adverse effects*; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005938:Glucocorticoids / Q000008:administration & dosage; D006801:Humans; D064729:Neurokinin-1 Receptor Antagonists; D012702:Serotonin Antagonists / Q000008:administration & dosage; D014839:Vomiting / Q000139:chemically induced* / Q000517:prevention & control*
chemical_list: D000932:Antiemetics; D000970:Antineoplastic Agents; D005938:Glucocorticoids; D064729:Neurokinin-1 Receptor Antagonists; D012702:Serotonin Antagonists