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Changes in the new MASCC/ESMO Guidelines (Update March 2016)
Dr. Karin Jordan
In light of new research data, a number of relevant innovations have now been incorporated into the MASCC/ESMO guidelines. First, 42 newly approved anti-cancer drugs were classified according to their emetogenic risk. Individual risk factors were not integrated into the primary prophylaxis algorithm. In analogy to ASCO guidelines, anthracycline/cyclophosphamide-based chemotherapy is now also classified as highly emetogenic.
The biggest change has occurred in the area of prophylaxis for moderately emetogenic chemotherapy. The main question was whether the additional administration of an NK1 receptor antagonist provides a relevant benefit. It became apparent that it was not possible to provide a single general anti-emetic prophylaxis recommendation for all moderately emetogenic chemotherapy. The most convincing studies in this area so far involve carboplatin-based chemotherapy. In light of these studies, for carboplatin-based chemotherapy, anti-emetic prophylaxis with a 5-HT3 receptor antagonist is recommended in combination with a NK1 receptor antagonist and a steroid.
Another change is that with highly emetogenic chemotherapy, prophylactic use of olanzapine (off-label use) in combination with a 5-HT3 receptor antagonist and a steroid is recommended as a possible option.