Advertisement

Optimizing antiemetic therapy for children undergoing chemotherapy

      Highlights

      • Chemotherapy-induced nausea and vomiting (CINV) impacts quality of life.
      • Reviews pediatric-specific recommendations for monitoring and pharmacotherapy for CINV.
      • Shares antiemetic algorithm and experience from our institution.

      Abstract

      Chemotherapy-induced nausea and vomiting (CINV) is a common side effect of most chemotherapy agents. Suboptimal management of CINV impacts quality of life, nutrition, gastrointestinal (GI) integrity, and adherence to chemotherapy treatment plans. This article reviews the principles of CINV management, planning and implementation of antiemetic regimens, and pharmacology of the antiemetics currently available in the United States appropriate for pediatric use. With the advent of more targeted therapies, increased use of immunotherapy, and the effects of radiotherapy to the brain, spine, and abdomen, treatment of CINV now has a broader application than just for chemotherapeutics alone.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      References

        • Aapro M.
        CINV: Still troubling patients after all these years.
        Supportive Care in Cancer. 2018; 26: 5-9
        • Aapro M.S.
        • Alberts D.S.
        High-dose dexamethasone for prevention of cis-platin-induced vomiting.
        Cancer Chemotherapy and Pharmacology. 1981; 7: 11-14
        • Abrams D.I.
        Should oncologists recommend Cannabis?.
        Current Treatment Options in Oncology. 2019; 20: 59
        • Baker P.D.
        • Morzorati S.L.
        • Ellett M.L.
        The pathophysiology of chemotherapy-induced nausea and vomiting.
        Gastroenterology Nursing. 2005; 28: 469-480
        • Barbour S.Y.
        Management of patients with chemotherapy-induced nausea and vomiting.
        Journal of the Advanced Practitioner in Oncology. 2017; 8: 303-308
        • Baxter A.
        • Watcha M.
        • Baxter W.
        • Leong T.
        • Wyatt M.
        Development and validation of a pictorial nausea rating scale for children.
        Pediatrics. 2011; 127: e1542-e1549
        • Bayo J.
        • Fonseca P.J.
        • Hernando S.
        • Servitja S.
        • Calvo A.
        • Falagan S.
        • Barnadas A.
        Chemotherapy-induced nausea and vomiting: Pathophysiology and therapeutic principles.
        Clinical and Translational Oncology. 2012; 14: 413-422
        • Bell G.C.
        • Caudle K.E.
        • Whirl-Carrillo M.
        • Gordon R.J.
        • Hikino K.
        • Prows C.A.
        • Schwab M.
        Clinical pharmacogenetics implementation consortium (CPIC) guideline for CYP2D6 genotype and use of ondansetron and tropisetron.
        Clinical Pharmacology and Therapeutics. 2017; 102: 213-218
        • Bosnjak S.M.
        • Dimitrijevic J.
        • Djordjevic F.
        Cancer and chemotherapy-induced nausea and vomiting: A focus on olanzapine.
        Current Opinion in Supportive and Palliative Care. 2016; 10: 180-188
        • Cabanillas Stanchi K.M.
        • Ebinger M.
        • Hartmann U.
        • Queudeville M.
        • Feucht J.
        • Ost M.
        • Döring M.
        Efficacy, safety and feasibility of antiemetic prophylaxis with fosaprepitant, granisetron and dexamethasone in pediatric patients with hemato-oncological malignancies.
        Drug Design, Development and Therapy. 2019; 13: 3439-3451
        • Cabanillas Stanchi K.M.
        • Vek J.
        • Schlegel P.
        • Rupprecht J.V.
        • Flaadt T.
        • Weber S.
        • Döring M.
        Antiemetic prophylaxis with fosaprepitant and granisetron in pediatric patients undergoing allogeneic hematopoietic stem cell transplantation.
        Journal of Cancer Research and Clinical Oncology. 2020; 146: 1089-1100
        • Chaudhary N.K.
        • John R.R.
        • Boddu D.
        • Mahasampath G.
        • Nesadeepam N.
        • Mathew L.G.
        Palonosetron is a better choice compared with ondansetron for the prevention of chemotherapy-induced nausea and vomiting (CINV) in a resource-limited pediatric oncology center: Results from a randomized control trial.
        Journal of Pediatric Hematology/Oncology. 2019; 41: 294-297
        • Dranitsaris G.
        • Molassiotis A.
        • Clemons M.
        • Roeland E.
        • Schwartzberg L.
        • Dielenseger P.
        • Jordan K.
        • Young A.
        • Aapro M.
        The development of a prediction tool to identify cancer patients at high risk for chemotherapy-induced nausea and vomiting.
        Annals of Oncology. 2017; 28: 1260-1267
        • Dupuis L.
        • Boodhan S.
        • Holdsworth M.
        • Robinson P.
        • Hain R.
        • Portwine C.
        • Pediatric Oncology Group of Ontario
        Guideline for prevention of acute nausea and vomiting due to antineoplastic medication in pediatric cancer patients.
        Pediatric Blood & Cancer. 2013; 60: 1073-1082
        • Dupuis L.
        • Johnston D.
        • Baggott C.
        • Hyslop S.
        • Tomlinson D.
        • Gibson P.
        • Sung L.
        Validation of the symptom screening in pediatrics tool in children receiving cancer treatments.
        Journal of the National Cancer Institute. 2018; 110: 661-668
        • Dupuis L.
        • Taddio A.
        • Kerr E.
        • Kelly A.
        • MacKeigan L.
        Development and validation of the pediatric nausea assessment tool for use in children receiving antineoplastic agents.
        Pharmotherapy. 2006; 26: 1221-1231
        • Dupuis L.
        • Tamura R.
        • Kelly K.
        • Krischer J.
        • Langevin A.
        • Chen L.
        • McLean T.
        Risk factors for chemotherapy-induced nausea in pediatric patients receiving highly emetogenic chemotherapy.
        Pediatric Blood & Cancer. 2019; 66e27584
        • Figueroa-Moseley C.
        • Jean-Pierre P.
        • Roscoe J.A.
        • Ryan J.L.
        • Kohli S.
        • Palesh O.G.
        • Morrow G.R.
        Behavioral interventions in treating anticipatory nausea and vomiting.
        Journal of the National Comprehensive Cancer Network: JNCCN. 2007; 5: 44-50
        • Flank J.
        • Schechter T.
        • Gibson P.
        • Johnston D.L.
        • Orsey A.D.
        • Portwine C.
        • Dupuis L.L.
        Olanzapine for prevention of chemotherapy-induced nausea and vomiting in children and adolescents: A multi-center, feasibility study.
        Supportive Care in Cancer. 2018; 26: 549-555
        • Gregory R.
        • Ettinger D.
        5-HT3 receptor antagonists for the prevention of chemotherapy-induced nausea and vomiting: A comparison of their pharmacology and clinical efficacy.
        Drugs. 1998; 55: 173-189
        • Gupta K.
        • Walton R.
        • Kataria S.P.
        Chemotherapy-induced nausea and vomiting: Pathogenesis, recommendations, and new trends.
        Cancer Treatment and Research Communications. 2021; 26100278
        • Hawkins R.
        • Grunberg S.
        Chemotherapy-induced nausea and vomiting: Challenges and opportunities for improved patient outcomes.
        Clinical Journal of Oncology Nursing. 2009; 13: 54-64
        • Hematology/Oncology Pharmacy Association, Eisai Inc, & Helsinn Therapeutics (U.S)
        The Time to Talk CINV toolkit from.
        • Hesketh P.
        • Kris M.
        • Basch E.
        • Bohle K.
        • Barbour S.Y.
        • Clark-Snow R.
        • Lyman G.
        Antiemetics: American Society of Clinical Oncology guideline update.
        Journal of Clinical Oncology. 2020; 38: 2782-2797
        • Ho K.Y.
        • Gan T.J.
        Pharmacology, pharmacogenetics, and clinical efficacy of 5-hydroxytryptamine type 3 receptor antagonists for postoperative nausea and vomiting.
        Current Opinion in Anaesthesiology. 2006; 19: 606-611
      1. ISMP 2020-2021 targeted medication safety best practices for hospitals. (2021). Retrieved May 24, 2022, from https://www.ismp.org/sites/default/files/attachments/2020-02/20202021%20TMSBP-%20FINAL_1.pdf

        • Jacobs S.S.
        • Dome J.S.
        • Gai J.
        • Gross A.M.
        • Postell E.
        • Hinds P.S.
        • Mowbray C.
        Pharmacogenetic and clinical predictors of ondansetron failure in a diverse pediatric oncology population.
        Supportive Care in Cancer. 2022; 30: 3513-3520
        • Kang H.J.
        • Loftus S.
        • Taylor A.
        • DiCristina C.
        • Green S.
        • Zwaan C.M.
        Aprepitant for the prevention of chemotherapy-induced nausea and vomiting in children: A randomised, double-blind, phase 3 trial.
        The Lancet. Oncology. 2015; 16: 385-394
        • Lexi-comp Online, Pediatric and Neonatal Lexi-Drugs Online
        Ondansetron. In Lexi-comp.
        https://online.lexi.com
        Date: 2022, May 20
        • Lexi-comp Online, Pediatric and Neonatal Lexi-Drugs Online
        Granisetron. In Lexi-comp.
        https://online.lexi.com
        Date: 2022, May 20
        • Lexi-comp Online, Pediatric and Neonatal Lexi-Drugs Online
        Palonosetron. In Lexi-comp.
        https://online.lexi.com
        Date: 2022, May 20
        • Lexi-comp Online, Pediatric and Neonatal Lexi-Drugs Online
        Fosaprepitant. In Lexi-comp.
        https://online.lexi.com
        Date: 2022, May 20
        • Lexi-comp Online, Pediatric and Neonatal Lexi-Drugs Online
        Olanzapine. In Lexi-comp.
        https://online.lexi.com
        Date: 2022, May 20
        • Lexi-comp Online, Pediatric and Neonatal Lexi-Drugs Online
        Dexamethasone. In Lexi-comp.
        https://online.lexi.com
        Date: 2022, May 20
        • Lexi-comp Online, Pediatric and Neonatal Lexi-Drugs Online
        Dronabinol. In Lexi-comp.
        https://online.lexi.com
        Date: 2022, May 20
        • Lexi-comp Online, Pediatric and Neonatal Lexi-Drugs Online
        Promethazine. In Lexi-comp.
        https://online.lexi.com
        Date: 2022, May 20
        • Lexi-comp Online, Pediatric and Neonatal Lexi-Drugs Online
        Lorazepam. In Lexi-comp.
        https://online.lexi.com
        Date: 2022, May 20
        • Lohr L.
        Chemotherapy-induced nausea and vomiting.
        The Cancer Journal. 2008; 14: 85-93
        • McKinnon K.
        • Jupp J.
        Integration of a nausea and vomiting assessment tool into antineoplastic management of pediatric oncology patients.
        Journal of Oncology Pharmacy Practice. 2020; 26: 1353-1360
        • Momani T.G.
        • Berry D.L.
        Integrative therapeutic approaches for the management and control of nausea in children undergoing cancer treatment: A systematic review of literature.
        Journal of Pediatric Oncology Nursing. 2017; 34: 173-184
        • Mora J.
        • Valero M.
        • DiCristina C.
        • Jin M.
        • Chain A.
        • Bickham K.
        Pharmacokinetics/pharmacodynamics, safety, and tolerability of fosaprepitant for the prevention of chemotherapy-induced nausea and vomiting in pediatric cancer patients.
        Pediatric Blood & Cancer. 2019; 66e27690
        • Naik R.D.
        • V S.
        • Singh V.
        • Pillai A.S.
        • Dhawan D.
        • Bakhshi S.
        Olanzapine for prevention of vomiting in children and adolescents receiving highly emetogenic chemotherapy: Investigator-initiated, randomized, open-label trial.
        Journal of Clinical Oncology. 2020; 38: 3785-3793
        • National Comprehensive Cancer Network
        Clinical practice guidelines in oncology.
        in: Antiemesis. NCCN guidelines V2. 2022: 2022
        • Navari R.
        Management of chemotherapy-induced nausea and vomiting in pediatric patients.
        Pediatric Drugs. 2017; 19: 213-222
        • Navari R.
        • Aapro M.
        Antiemetic prophylaxis for chemotherapy-induced nausea and vomiting.
        New England Journal of Medicine. 2016; 374: 1356-1367
        • Patel P.
        • Leeder J.S.
        • Piquette-Miller M.
        • Dupuis L.L.
        Aprepitant and fosaprepitant drug interactions: A systematic review.
        British Journal of Clinical Pharmacology. 2017; 83: 2148-2162
        • Patel P.
        • Robinson P.D.
        • Thackray J.
        • Flank J.
        • Holdsworth M.T.
        • Gibson P.
        • Dupuis L.L.
        Guideline for the prevention of acute chemotherapy-induced nausea and vomiting in pediatric cancer patients: A focused update.
        Pediatric Blood & Cancer. 2017; 64
        • Paw Cho Sing E.
        • Robinson P.D.
        • Flank J.
        • Holdsworth M.
        • Thackray J.
        • Freedman J.
        • Dupuis L.L.
        Classification of the acute emetogenicity of chemotherapy in pediatric patients: A clinical practice guideline.
        Pediatric Blood & Cancer. 2019; 66e27646
        • Radhakrishnan V.
        • Joshi A.
        • Ramamoorthy J.
        • Rajaraman S.
        • Ganesan P.
        • Ganesan T.S.
        • Sagar T.G.
        Intravenous fosaprepitant for the prevention of chemotherapy-induced vomiting in children: A double-blind, placebo-controlled, phase III randomized trial.
        Pediatric Blood & Cancer. 2019; 66e27551
        • Roila F.
        • Molassiotis A.
        • Herrstedt J.
        • Aapro M.
        • Gralla R.J.
        • Bruera E.
        • participants of the MASCC/ESMO Consensus Conference Copenhagen 2015
        2016 MASCC and ESMO guideline update for the prevention of chemotherapy- and radiotherapy-induced nausea and vomiting and of nausea and vomiting in advanced cancer patients.
        Annals of Oncology. 2016; 27: v119-v133
        • Rower J.E.
        • King A.D.
        • Wilkins D.
        • Wilkes J.
        • Yellepeddi V.
        • Maese L.
        • Constance J.E.
        Dronabinol prescribing and exposure among children and young adults diagnosed with cancer.
        Journal of Adolescent and Young Adult Oncology. 2021; 10: 175-184
        • Saito Y.
        • Kumamoto T.
        • Arima T.
        • Shirakawa N.
        • Ishimaru S.
        • Sonoda T.
        • Nakajima M.
        • Sugiyama M.
        • Arakawa A.
        • Hashimoto H.
        • Makino Y.
        • Ogawa C.
        • Yamaguchi M.
        Evaluation of aprepitant and fosaprepitant in pediatric patients.
        Pediatrics International. 2019; 61: 235-239
        • Sanger G.J.
        • Andrews P.
        A history of drug discovery for treatment of nausea and vomiting and the implications for future research.
        Frontiers in Pharmacology. 2018; 9: 913
        • Sherani F.
        • Boston C.
        • Mba N.
        Latest update on prevention of acute chemotherapy-induced nausea and vomiting in pediatric cancer patients.
        Current Oncology Reports. 2019; 21: 89
        • Sommariva S.
        • Pongiglione B.
        • Tarricone R.
        Impact of chemotherapy- induced nausea and vomiting on health-related quality of life and resource utilization: A systematic review.
        Critical Reviews in Oncology/Hematology. 2016; 99: 13-36
        • Tan J.
        • Wang S.
        • Liang X.
        • Li C.C.
        • Zhang J.
        • Zhao Z.
        • Yang C.
        Palonosetron is nonsuperior to ondansetron in acute phase but provides superior antiemetic control in delayed phase for pediatric patients administered highly emetogenic chemotherapy.
        Pediatric Blood & Cancer. 2018; 65
        • Tricco A.C.
        • Blondal E.
        • Veroniki A.A.
        • Soobiah C.
        • Vafaei A.
        • Ivory J.
        • Straus S.E.
        Comparative safety and effectiveness of serotonin receptor antagonists in patients undergoing chemotherapy: A systematic review and network meta-analysis.
        BMC Medicine. 2016; 14: 216
        • Triozzi P.
        • Laszlo J.
        Optimum management of nausea and vomiting in cancer chemotherapy.
        Practical Therapeutics. 1987; 24: 136-149
        • Watcha M.
        • Lee A.
        • Medellin E.
        • Felberg M.T.
        • Bidani S.
        Clinical use of the pictorial Baxter retching faces scale for measurement of postoperative nausea in children.
        Anesthesia and Analgesia. 2019; 128: 1249-1255
        • Willier S.
        • Cabanillas Stanchi K.M.
        • von Have M.
        • Binder V.
        • Blaeschke F.
        • Feucht J.
        • Döring M.
        Efficacy, safety and feasibility of fosaprepitant for the prevention of chemotherapy-induced nausea and vomiting in pediatric patients receiving moderately and highly emetogenic chemotherapy - results of a non-interventional observation study.
        BMC Cancer. 2019; 19: 1118