title: Measuring the impact of guideline-based antiemetic therapy on nausea and vomiting control in breast cancer patients with multiple risk factors.
abstract: OBJECTIVE
  The objective of this exploratory analysis was to determine if individual patient risk factors could be used to optimize chemotherapy-induced nausea and vomiting (CINV).
  
  
  METHODS
  Through validated risk prediction models which quantify patient risk factors, 152 patients with early-stage breast cancer scheduled to received adjuvant anthracycline-based chemotherapy were categorized as being at low (level 0) or high-risk (level 1) for CINV. Prior to the first cycle of chemotherapy, low-risk patients received ondansetron and dexamethasone, while high-risk level 1 patients also received aprepitant. For subsequent cycles, patients who experienced CINV had their antiemetics changed in a stepwise manner to level 2 (extended-duration dexamethasone) or level 3 (extended-duration dexamethasone and low-dose olanzapine).
  
  
  RESULTS
  The study enrolled 152 patients who received 484 cycles of chemotherapy. Forty patient cycles were classified as low risk (level 0) compared to 201, 162 and 81 that were classified as high-risk levels 1, 2 and 3, respectively. Complete control of acute and delayed vomiting was comparable and was achieved in over 85 % of patients across all risk levels (p = 0.56 and p = 0.99). In contrast, complete control of acute and delayed nausea was reduced in risk levels 1 to 3 compared to level 0 (acute = 51.2, 58.0, 45.7 vs. 70.0 %; p = 0.013)-(delayed = 32.8, 45.7, 34.6 vs. 62.5 %; p < 0.001).
  
  
  CONCLUSIONS
  Despite the addition of aprepitant, extended-duration dexamethasone and olanzapine, patients at high risk for CINV due to personal risk factors failed to achieve good nausea control.
authors.affiliation: The Ottawa Hospital Cancer Centre, Ottawa, Canada. george.dranitsaris@gmail.com.|, 283 Danforth Ave, Suite 448, Toronto, Ontario, M4K 1N2, Canada. george.dranitsaris@gmail.com.
authors.forename: George
authors.initials: G
authors.lastname: Dranitsaris
authors.affiliation: The Ottawa Hospital Cancer Centre, Ottawa, Canada.
authors.forename: Sasha
authors.initials: S
authors.lastname: Mazzarello
authors.affiliation: The Ottawa Hospital Cancer Centre, Ottawa, Canada.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Smith
authors.affiliation: The Ottawa Hospital Cancer Centre, Ottawa, Canada.
authors.forename: Lisa
authors.initials: L
authors.lastname: Vandermeer
authors.affiliation: The Ottawa Hospital Cancer Centre, Ottawa, Canada.
authors.forename: Nathaniel
authors.initials: N
authors.lastname: Bouganim
authors.affiliation: The Ottawa Hospital Cancer Centre, Ottawa, Canada.
authors.forename: Mark
authors.initials: M
authors.lastname: Clemons
mesh_terms: D000328:Adult; D000368:Aged; D000932:Antiemetics / Q000008:administration & dosage / Q000494:pharmacology*; D000970:Antineoplastic Agents / Q000009:adverse effects*; D000077608:Aprepitant; D001943:Breast Neoplasms / Q000188:drug therapy*; D003907:Dexamethasone / Q000008:administration & dosage / Q000494:pharmacology*; D005260:Female; D006801:Humans; D008875:Middle Aged; D009025:Morpholines / Q000008:administration & dosage / Q000494:pharmacology*; D009325:Nausea / Q000139:chemically induced / Q000188:drug therapy*; D017294:Ondansetron / Q000008:administration & dosage / Q000494:pharmacology*; D017063:Outcome Assessment, Health Care; D017410:Practice Guidelines as Topic; D012307:Risk Factors; D014839:Vomiting / Q000139:chemically induced / Q000188:drug therapy*
chemical_list: D000932:Antiemetics; D000970:Antineoplastic Agents; D009025:Morpholines; D000077608:Aprepitant; D017294:Ondansetron; D003907:Dexamethasone
keywords: Aprepitant; Chemotherapy; Nausea; Randomized trial; Risk prediction; Vomiting