Antiemetics in children receiving chemotherapy. MASCC/ESMO guideline update 2009.
Only a few studies have been carried out in children on the prevention of chemotherapy-induced nausea and vomiting (CINV). 5-HT(3) receptor antagonists have been shown to be more efficacious and less toxic than metoclopramide, phenothiazines and cannabinoids. Most dose studies are available for the 5-HT(3) receptor antagonists ondansetron and granisetron. The new 5-HT(3) receptor antagonist palonosetron was evaluated in one comparative study so far showing promising activity. Combinations of a 5-HT(3) receptor antagonist and dexamethasone showed increased efficacy with respect to a 5-HT(3) receptor antagonist alone. All paediatric patients receiving chemotherapy of high or moderate emetogenic potential should receive a combination of a 5-HT(3) receptor antagonist and dexamethasone to prevent acute emesis. No studies have specifically evaluated antiemetic drugs in the prevention of chemotherapy-induced delayed and anticipatory emesis in children. The role of the NK1 receptor antagonists in children has to be further investigated, although one small study is published so far, showing promising activity in the prevention of CINV with aprepitant. The new proposed guideline from the Multinational Association of Supportive Care in Cancer and the European Society of Clinical Oncology summarises the updated data from the literature and takes into consideration the existing guidelines.
Jordan
Karin
K
Department of Medical Oncology and Hematology, University of Halle, Ernst Grube Strasse 40, Halle, Germany. Karin.jordan@medizin.uni-halle.de
Roila
Fausto
F
Molassiotis
Alexander
A
Maranzano
Ernesto
E
Clark-Snow
Rebecca A
RA
Feyer
Petra
P
D000293:Adolescent; D000932:Antiemetics / Q000008:administration & dosage*; D000970:Antineoplastic Agents / Q000009:adverse effects*; D002648:Child; D004334:Drug Administration Schedule; D005938:Glucocorticoids / Q000008:administration & dosage; D006801:Humans; D009325:Nausea / Q000139:chemically induced* / Q000188:drug therapy / Q000517:prevention & control*; D064729:Neurokinin-1 Receptor Antagonists; D012702:Serotonin Antagonists / Q000008:administration & dosage; D014839:Vomiting / Q000139:chemically induced* / Q000188:drug therapy / Q000517:prevention & control*
D000932:Antiemetics; D000970:Antineoplastic Agents; D005938:Glucocorticoids; D064729:Neurokinin-1 Receptor Antagonists; D012702:Serotonin Antagonists