Skip to main content

Advertisement

SpringerLink
Log in

Measuring the impact of guideline-based antiemetic therapy on nausea and vomiting control in breast cancer patients with multiple risk factors

  • Original Article
  • Published:
Supportive Care in Cancer Aims and scope Submit manuscript

Abstract

Purpose

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Hesketh P (1994) Treatment of chemotherapy-induced emesis in the 1990s: impact of the 5-HT3 receptor antagonists. Support Care Cancer 2:286–292

    Article  CAS  PubMed  Google Scholar 

  2. Schmoll HJ, Aapro MS, Poli-Bigelli S, et al. (2006) Comparison of an aprepitant regimen with a multiple-day ondansetron regimen, both with dexamethasone, for anti-emetic efficacy in high-dose cisplatin treatment. Ann Oncol 7:1000–1006

    Article  Google Scholar 

  3. Hocking CM, Kichenadasse G (2014) Olanzapine for chemotherapy-induced nausea and vomiting: a systematic review. Support Care Cancer 22:1143–1151

    Article  PubMed  Google Scholar 

  4. Navari RM, Nagy CK, Gray SE (2013) The use of olanzapine versus metoclopramide for the treatment of breakthrough chemotherapy-induced nausea and vomiting in patients receiving highly emetogenic chemotherapy. Support Care Cancer 21:1655–1663

    Article  PubMed  Google Scholar 

  5. Basch E, Prestrud AA, Hesketh PJ, et al. (2011) Antiemetics: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol 29:4189–4198

    Article  PubMed  Google Scholar 

  6. Herrstedt J, Roila F, Guidelines Working Group ESMO (2009) Chemotherapy-induced nausea and vomiting: ESMO clinical recommendations for prophylaxis. Ann Oncol 20(Suppl 4):156–158

    PubMed  Google Scholar 

  7. Dranitsaris G, Joy A, Young S, et al. (2009) Identifying patients at high-risk for nausea and vomiting after chemotherapy: the development of a practical prediction tool. J Supp Oncol 7:W1–W8

    Google Scholar 

  8. Petrella T, Clemons M, Joy A, et al. (2009) Identifying patients at high risk for nausea and vomiting after chemotherapy: the development of a practical validated prediction tool. J Supp Oncol:W9–W16

  9. Aapro MS, Bohlius J, Cameron DA, et al. (2011) 2010 update of EORTC guidelines for the use of granulocyte-colony stimulating factor to reduce the incidence ofchemotherapy induced febrile neutropenia in adult patients with lymphoproliferative disorders and solid tumours. Eur J Cancer 47:8–32

    Article  CAS  PubMed  Google Scholar 

  10. Smith TJ, Khatcheressian J, Lyman GH, et al. (2006) 2006 update of recommendations for the use of white blood cell growth factors: an evidence-based clinical practice guideline. J Clin Oncol 24:3187–3205

    Article  CAS  PubMed  Google Scholar 

  11. Bouganim N, Dranitsaris G, Hopkins S, et al. (2012) Prospective validation of risk prediction indices for acute and delayed chemotherapy-induced nausea and vomiting. Curr Oncol 19:e414–e421

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  12. Dranitsaris G, Bouganim N, Milano C, et al. (2013) Prospective validation of a prediction tool for identifying patients at high-risk for chemotherapy-induced nausea and vomiting. J Support Oncol 11:14–21

    PubMed  Google Scholar 

  13. Clemons M, Bouganim N, Smith S, et al. (2015) A randomized trial comparing risk model guided antiemetic prophylaxis to physician’s choice in patients receiving chemotherapy for early stage breast cancer. JAMA Oncol(in press)

  14. Decker GM, DeMeyer ES, Kisko DL (2006) Measuring the maintenance of daily life activities using the functional living index-emesis (FLIE) in patients receiving moderately emetogenic chemotherapy. J Support Oncol 4(35–41):52

    Google Scholar 

  15. Martin AR, Pearson JD, Cai B, et al. (2003) Assessing the impact of chemotherapy-induced nausea and vomiting on patients’ daily lives: a modified version of the Functional Living Index-Emesis (FLIE) with 5-day recall. Support Care Cancer 11:522–527

    Article  CAS  PubMed  Google Scholar 

  16. Saito H, Yoshizawa H, Yoshimori K, et al. (2013) Efficacy and safety of single-dose fosaprepitant in the prevention of chemotherapy-induced nausea and vomiting in patients receiving high-dose cisplatin: a multicentre, randomised, double-blind, placebo-controlled phase 3 trial. Ann Oncol 24:1067–1073

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  17. Grunberg S, Chua D, Maru A, et al. (2011) Single-dose fosaprepitant for the prevention of chemotherapy-induced nausea and vomiting associated with cisplatin therapy: randomized, double-blind study protocol–EASE. J Clin Oncol 29:1495–1501

    Article  CAS  PubMed  Google Scholar 

  18. Hesketh PJ, Rossi G, Rizzi G, et al. (2014) Efficacy and safety of NEPA, an oral combination of netupitant and palonosetron, for prevention of chemotherapy-induced nausea and vomiting following highly emetogenic chemotherapy: a randomized dose-ranging pivotal study. Ann Oncol 25:1340–1346

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  19. Tamura K, Aiba K, Saeki T, Nakanishi Y, et al. (2015). Testing the effectiveness of antiemetic guidelines: results of a prospective registry by the CINV Study Group of Japan. Int J Clin Oncol Feb 15.

  20. Foubert J, Vaessen G (2005) Nausea: the neglected symptom? Eur J Oncol Nurs 9:21–32

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The EPIC study investigators will like to express their gratitude to The Canadian Breast Cancer Research Foundation who funded the study, the research associates Stephanie Guillemot, Patti Spencer and Joanne Roach, the oncologists who enrolled patients into the study and especially the patients and their families.

Conflict of interest

None of the authors has a financial relationship with the organization that sponsored the research. The lead author had full control of all primary data and will allow the journal to review the data if requested.

Author information

Authors and Affiliations

  1. The Ottawa Hospital Cancer Centre, Ottawa, Canada

    George Dranitsaris, Sasha Mazzarello, Stephanie Smith, Lisa Vandermeer, Nathaniel Bouganim & Mark Clemons

  2. 283 Danforth Ave, Suite 448, Toronto, Ontario, M4K 1N2, Canada

    George Dranitsaris

Authors
  1. George Dranitsaris
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sasha Mazzarello
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Stephanie Smith
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Lisa Vandermeer
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Nathaniel Bouganim
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Mark Clemons
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to George Dranitsaris.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Dranitsaris, G., Mazzarello, S., Smith, S. et al. Measuring the impact of guideline-based antiemetic therapy on nausea and vomiting control in breast cancer patients with multiple risk factors. Support Care Cancer 24, 1563–1569 (2016). https://doi.org/10.1007/s00520-015-2944-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00520-015-2944-x

Keywords

Search

Navigation