Monday, September 25, 2023
| Rank | 1983 (Coates et al.2) | 1996 (Griffin et al.3) | 1997 (de Boer-Dennert et al.1) | 1999 (Lindley et al.4) | 2004 (Hofman et al.5) |
|---|---|---|---|---|---|
| 1 | Vomiting | Nausea | Nausea | Nausea | Fatigue |
| 2 | Nausea | Constantly tired | Hair loss | Hair loss | Nausea |
| 3 | Hair loss | Hair loss | Vomiting | Constantly tired | Sleep disturbances |
| 4 | Thought of treatment | Effect of family | Constantly tired | Vomiting | Weight loss |
| 5 | Length of treatment | Vomiting | Injections | Taste changes | Hair loss |
Patient Perceptions of the Most Severe Side Effects of Cancer Chemotherapy
| High (> 90% Chance of CINV Without Prophylaxis) | |||
| AC combination (doxorubicin or epirubicin with cyclophosphamide) Carmustine (> 250 mg/m2) Cisplatin (≥ 50 mg/m2) Cyclophosphamide (> 1500 mg/m2) Dacarbazine |
Doxorubicin (> 60 mg/m2) Epirubicin (> 90 mg/m2) Ifosfamide (≥ 10 g/m2) Mechlorethamine Streptozocin |
||
| Moderate (30%–90% Chance of CINV Without Prophylaxis) | |||
| Amifostine (> 300 mg/m2) Arsenic trioxide Azacitidine Bendamustine Busulfan Carboplatin Carmustine (≤ 250 mg/m2) Cisplatin (< 50 mg/m2) Clofarabine Cyclophosphamide (≤ 1500 mg/m2) Cytarabine (> 200 mg/m2) Dactinomycin |
Daunorubicin Doxorubicin (≤ 60 mg/m2) Epirubicin (≤ 90 mg/m2) Idarubicin Ifosfamide (< 10 g/m2) Interferon (≥ 10 million IU/m2) Interleukin-2 (> 12–15 million IU/m2) Irinotecan Melphalan Methotrexate (250 to > 1000 mg/m2) Oxaliplatin Temozolomide |
||
| Low (10%–30% Chance of CINV Without Prophylaxis) | |||
| Amifostine (≤ 300 mg/m2) Cabazitaxel Cytarabine (100–200 mg/m2) Docetaxel Eribulin Etoposide 5-Fluorouracil Floxuridine Gemcitabine Interferon (> 5 to < 10 million IU/m2) Interleukin-2 (≤ 12 million IU/m2) Ixabepilone |
Liposomal doxorubicin Methotrexate (> 50 to < 250 mg/m2) Mitomycin Mitoxantrone Paclitaxel Paclitaxel-albumin Pemetrexed Pralatrexate Pentostatin Romidepsin Thiotepa Topotecan |
||
| Minimal (< 10% Chance of CINV Without Prophylaxis) | |||
| Alemtuzumab Asparaginase Bevacizumab Bleomycin Bortezomib Cetuximab Cladribine |
Cytarabine (< 100 mg/m2) Decitabine Denileukin diftitox Dexrazoxane Fludarabine Interferon (≤ 5 million/units/m2) Ipilimumab |
Methotrexate (≤ 50 mg/m2) Nelarabine Ofatumumab Panitumumab Pegaspargase Peginterferon Rituximab |
Temsirolimus Trastuzumab Valrubicin Vinblastine Vincristine Vinorelbine |
Emetogenicity of Intravenous Chemotherapeutic Agents
Abbreviation: CINV, chemotherapy-induced nausea and vomiting.
Data from Refs.[8–10]
| NCCN | ASCO | MASCC | |
|---|---|---|---|
| High | |||
|
12 mg po or IV 8 mg po days 2–4 or 8mg po day 2, 8 mg twice daily days 3 and 4a |
12 mg po or IV 8 mg po or IV; days 2–3 or days 2–4 |
20 mg (12 mg if used with an NK1 antagonist) 8 mg bid for 3-4 d (qd with NK1 antagonist) |
| Moderate | |||
|
12 mg po or IV 8 mg po or IV days 2 and 3 |
8 mg po or IV 8 mg po or IV days 2 and 3 |
8 mg 8 mg for 2–3 d |
| Low | 12 mg po or IV | 8 mg po or IV | 4-8 mg |
Corticosteroid Dosing Recommendations
All corticosteroid doses for moderate and high regimens are in combination with a 5HT3 antagonist +/- a neurokinin-1 antagonist.
Abbreviations: IV, intravenous; MASCC, Multinational Association of Supportive Care in Cancer; NK1, neurokinin-1.
aWhen given with fosaprepitant, 150 mg IV.
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Health Sciences Clinical Professor; Residency Director, Department of Family Medicine, University of California, Irvine
This activity is intended for primary care physicians, oncologists, and other physicians who care for patients with cancer.
The goal of this activity is to evaluate the role of corticosteroids in the treatment of CINV.
Upon completion of this activity, participants will be able to:
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Health Sciences Clinical Professor; Residency Director, Department of Family Medicine, University of California, Irvine
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Chemotherapy-induced nausea and vomiting (CINV) is one of the most feared side effects of cancer treatment, despite the advances over the past decades. Corticosteroids have been shown to be effective in the management of CINV. These agents are usually used in combination with serotonin antagonists and neurokinin-1 antagonists for highly or moderately emetogenic chemotherapy or as monotherapy for low-emetogenic chemotherapy. Consensus guidelines provide guidance regarding the scenarios in which corticosteroids are recommended. This article reviews the mechanism of action, role, and safety of corticosteroids in the management of CINV. (JNCCN 2012;10:493–500)
Chemotherapy-induced nausea and vomiting (CINV) is one of the most feared side effects of cancer treatment and is a cause of great distress for many patients.[1] In rankings of symptoms, vomiting and/or nausea has always been at the top ( Table 1 )[1–5]; although with recent advances in treatment and control of vomiting, nausea continues to be the more problematic symptom. In fact, in a recent survey of women receiving cisplatin-based chemotherapy for gynecologic malignancies, the potential for uncontrolled CINV ranked just above death as a cause of symptom distress.[6] In addition to the distress and impairment of quality of life CINV causes patients, it can lead to serious complications, such as dehydration, electrolyte abnormalities, Mallory-Weiss tears, compromised ability to deliver chemotherapy, and increased hospital costs.[7] Although many advances have been made in understanding the origin and pathophysiology of CINV and in the development of new agents, it is still an issue of concern for many patients and clinicians.
