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What is the optimal anti-emetic therapy for Isabella?
Presentation by Dr. Snezana Bosnjak at MASCC/ISOO Annual Meeting June 23-25 2016, Adelaide
Dr Snezana Bosnjak is a Consultant Clinical Pharmacologist at the Institute for Oncology and Radiology in Serbia. In evaluating Isabella’s emetic risk, she was found to have individual factors that increased her risk of vomiting (such as being female, having previously suffered morning sickness, and being anxious and anticipating vomiting), and those that decreased her risk (such as being chemotherapy naïve and not suffering from motion sickness). Isabella’s treatment regimen included the moderately emetogenic carboplatin, which has an 82-84% chance of causing acute vomiting and a potential for delayed nausea and vomiting. Dr Bosnjak reviewed three trials on improving chemotherapy-induced nausea and vomiting (CINV) in regimens that include carboplatin.
Based on the positive results in these trials, the antiemetic guidelines produced by MASCC and ESMO recommend adding an NK1-receptor antagonist to 5-HT3 antagonist and dexamethasone to optimally prevent acute nausea and vomiting induced by carboplatin.
Dr Bosnjak then assessed the audience’s stance on taking individual risk factors into account when assessing the risk of CINV, and if an algorithm would be helpful in assessing this risk. With a triplet regimen given to Isabella, her vomiting was managed, but she still experienced Grade 2 nausea. On Day 10 of Cycle 2, Isabella reported several gastrointestinal toxicity symptoms.