Blood & Cancer

Blood & Cancer: A hematology-oncology podcast from MDedge


 

In the first episode of Blood & Cancer, David Henry, MD (http://bit.ly/2MFDfzm), welcomes Richard J. Gralla, MD (http://bit.ly/2ShsxEv), or the Albert Einstein College of Medicine in New York. The topic today centers around antiemetics and ways to use them. And later, Ilana Yurkiewicz, MD (https://stanford.io/2RXPixR), debuts her segment Clinical Correlations all about hematology care.
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Show Notes

By Emily Bryer, DO

  • Highly emetic chemotherapy regimens include cisplatin, dacarbazine, anthracycline, and cyclophosphamide combinations
    • Treatment should include an NK1 receptor antagonist, dexamethasone, and a 5HT3 antagonist
    • All 5HT3 antagonists should be given only once (no evidence that prn or delayed administration is helpful)
    • Olanzapine is an effective antiemetic, although its precise role and dose are undergoing investigation
    • An all-oral regimen for highly emetic could include Netupitant (NK1) and palonosetron (long-acting 5HT3) (NEPA) + Oral Dex + Olanzapine
  • Moderately emetic chemotherapy regimens include irinotecan and taxotere
    • Treatment should include 5HT3 antagonist and dexamethasone
  • Carboplatin causes more emesis than initially thought
    • Improvement with NK1 antagonist yields a 15% decreased risk of emesis
    • Guidelines now recommending NK1 with carboplatin
  • Low emetic chemotherapy regimens include gemcitabine, pemetrexed as single agent
    • Single drug: one dose of corticosteroid or one dose of 5HT3 antagonist
  • Minimal emetic chemotherapy regimens include vincristine or bleomycin
    • No drugs are recommended for acute or delayed nausea/emesis
  • 20 mg Dexamethasone IV (or 12 mg PO 12 mg) should be administered only on day 1 of chemotherapy. Dexamethasone can be spared after that unless cisplatin (would require 2 days of steroids)
  • Marijuana and THC have some antiemetic properties, but are about one quarter as effective as 5HT3 antagonists
  • Lorazepam may be used in anticipatory emesis started a few days prior to chemotherapy

References:

Ann Oncol. 2014 Jul;25(7):1333-9.

JCSO 2015;13(4):128-30.

JCSO 2016;4(1):11-20.

Contact us: podcasts@mdedge.com

MDedge on Twitter: @mdedgehemonc

Dr. Ilana Yurkiewicz on Twitter: @ilanayurkiewicz

Dr. Yurkiewicz on MDedge: http://bit.ly/2DItTAb

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