Paul J Hesketh1, Mark G Kris2, Ethan Basch3, Kari Bohlke4, Sally Y Barbour5, Rebecca Anne Clark-Snow6, Michael A Danso7, Kristopher Dennis8,9, L Lee Dupuis10, Stacie B Dusetzina11,12, Cathy Eng12, Petra C Feyer13, Karin Jordan14, Kimberly Noonan15, Dee Sparacio16, Gary H Lyman17. 1. Lahey Hospital and Medical Center, Burlington, MA. 2. Memorial Sloan Kettering Cancer Center, New York, NY. 3. University of North Carolina at Chapel Hill, Chapel Hill, NC. 4. American Society of Clinical Oncology, Alexandria, VA. 5. Duke University Medical Center, Durham, NC. 6. Overland Park, KS. 7. Virginia Oncology Associates, Norfolk and Virginia Beach, VA. 8. The Ottawa Hospital, Ottawa, Ontario, Canada. 9. University of Ottawa, Ottawa, Ontario, Canada. 10. The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada. 11. Vanderbilt University School of Medicine, Nashville, TN. 12. Vanderbilt-Ingram Cancer Center, Nashville, TN. 13. Clinic of Radio-Oncology and Nuclear Medicine, Vivantes Clinics Neukoelln, Berlin, Germany. 14. Department of Medicine V, University of Heidelberg, Heidelberg, Germany. 15. Dana-Farber Cancer Institute, Boston, MA. 16. Patient Representative, Hightstown, NJ. 17. Fred Hutchinson Cancer Research Center and University of Washington, Seattle, WA.
Abstract
PURPOSE: To update the guideline to include new anticancer agents, antiemetics, and antiemetic regimens and to provide recommendations on the use of dexamethasone as a prophylactic antiemetic in patients receiving checkpoint inhibitors (CPIs). METHODS: ASCO convened an Expert Panel and updated the systematic review to include randomized controlled trials (RCTs) and meta-analyses of RCTs published between June 1, 2016, and January 24, 2020. To address the dexamethasone and CPI question, we conducted a systematic review of RCTs that evaluated the addition of a CPI to chemotherapy. RESULTS: The systematic reviews included 3 publications from the updated search and 10 publications on CPIs. Two phase III trials in adult patients with non-small-cell lung cancers evaluating a platinum-based doublet with or without the programmed death 1 (PD-1) inhibitor pembrolizumab recommended that all patients receive dexamethasone as a component of the prophylactic antiemetic regimen. In both studies, superior outcomes were noted in the PD-1 inhibitor-containing arms. Other important findings address olanzapine in adults and fosaprepitant in pediatric patients. RECOMMENDATIONS: Recommendations for adults are unchanged with the exception of the option of adding olanzapine in the setting of hematopoietic stem cell transplantation. Dosing information now includes the option of a 5-mg dose of olanzapine in adults and intravenous formulations of aprepitant and netupitant-palonosetron. The option of fosaprepitant is added to pediatric recommendations. There is no clinical evidence to warrant omission of dexamethasone from guideline-compliant prophylactic antiemetic regimens when CPIs are administered to adults in combination with chemotherapy. CPIs administered alone or in combination with another CPI do not require the routine use of a prophylactic antiemetic.Additional information is available at www.asco.org/supportive-care-guidelines.
PURPOSE: To update the guideline to include new anticancer agents, antiemetics, and antiemetic regimens and to provide recommendations on the use of dexamethasone as a prophylactic antiemetic in patients receiving checkpoint inhibitors (CPIs). METHODS: ASCO convened an Expert Panel and updated the systematic review to include randomized controlled trials (RCTs) and meta-analyses of RCTs published between June 1, 2016, and January 24, 2020. To address the dexamethasone and CPI question, we conducted a systematic review of RCTs that evaluated the addition of a CPI to chemotherapy. RESULTS: The systematic reviews included 3 publications from the updated search and 10 publications on CPIs. Two phase III trials in adult patients with non-small-cell lung cancers evaluating a platinum-based doublet with or without the programmed death 1 (PD-1) inhibitor pembrolizumab recommended that all patients receive dexamethasone as a component of the prophylactic antiemetic regimen. In both studies, superior outcomes were noted in the PD-1 inhibitor-containing arms. Other important findings address olanzapine in adults and fosaprepitant in pediatric patients. RECOMMENDATIONS: Recommendations for adults are unchanged with the exception of the option of adding olanzapine in the setting of hematopoietic stem cell transplantation. Dosing information now includes the option of a 5-mg dose of olanzapine in adults and intravenous formulations of aprepitant and netupitant-palonosetron. The option of fosaprepitant is added to pediatric recommendations. There is no clinical evidence to warrant omission of dexamethasone from guideline-compliant prophylactic antiemetic regimens when CPIs are administered to adults in combination with chemotherapy. CPIs administered alone or in combination with another CPI do not require the routine use of a prophylactic antiemetic.Additional information is available at www.asco.org/supportive-care-guidelines.
Authors: Rudolph M Navari; Kathryn J Ruddy; Thomas W LeBlanc; Ryan Nipp; Rebecca Clark-Snow; Lee Schwartzberg; Gary Binder; William L Bailey; Ravi Potluri; Luke M Schmerold; Eros Papademetriou; Eric J Roeland Journal: Oncologist Date: 2020-12-21
Authors: Marziyeh Ghorbani; Mehdi Dehghani; Noushin Fahimfar; Soha Namazi; Ali Dehshahri Journal: Support Care Cancer Date: 2022-01-17 Impact factor: 3.603