Jordan Karin, de Azambuja Evandro, García Del Barrio María Ángeles, Jahn Franziska, Di Palma Mario, Scotté Florian, Molassiotis Alex, Aapro Matti
Department of Hematology, Oncology and Palliative Care, Ernst von Bergmann Hospital Potsdam, Germany; Department of Hematology, Oncology and Rheumatology, University Hospital Heidelberg, Heidelberg, Germany.
Institut Jules Bordet, Hôpital Universitaire de Bruxelles (H.U.B) and l'Université Libre de Bruxelles (ULB), Brussels, Belgium.
Eur J Cancer. 2025 Jun 3;222:115451. doi: 10.1016/j.ejca.2025.115451. Epub 2025 Apr 19.
The MASCC/ESMO guidelines for the prevention of chemotherapy- and radiotherapy-induced nausea and vomiting were updated in 2023 by a Consensus Committee of 34 multidisciplinary international healthcare professionals and three patient advocates. Guideline-recommended prophylactic anti-emetic strategies can control chemotherapy-induced nausea and vomiting (CINV) in many patients, but unaddressed issues remain. Across a series of meetings, we evaluated these guidelines to identify possible evidence gaps which warrant further exploration. Key topics identified and discussed included the use of dexamethasone-sparing regimens with cisplatin (and other non-anthracycline and cyclophosphamide)-based highly emetogenic chemotherapy regimens, the importance of individual patient risk factors for CINV, the use of a second agent in patients receiving low emetogenic chemotherapy, how to manage CINV with certain new antibody-drug conjugates, the most appropriate approach for managing breakthrough CINV, the options for patients with CINV even after following best guidance, the use of lower than standard doses of olanzapine (<10 mg/day), and the management of long-delayed CINV and CINV in patients receiving oral therapies. Through identifying the current gaps in the updated MASCC/ESMO guidelines and discussing the available evidence, we aim to address these issues and support oncologists who may encounter them in clinical practice. These and other questions need to be considered to help ensure choice of anti-emetic treatments provide optimal effectiveness in clinical practice.
2023年，由34名多学科国际医疗保健专业人员和3名患者权益倡导者组成的共识委员会对MASCC/ESMO预防化疗和放疗引起的恶心和呕吐指南进行了更新。指南推荐的预防性止吐策略可以控制许多患者的化疗引起的恶心和呕吐（CINV），但仍存在未解决的问题。在一系列会议中，我们评估了这些指南，以确定可能需要进一步探索的证据空白。确定并讨论的关键主题包括在基于顺铂（以及其他非蒽环类和环磷酰胺）的高致吐性化疗方案中使用减少地塞米松的方案、CINV个体患者风险因素的重要性、接受低致吐性化疗的患者使用第二种药物的情况、如何使用某些新的抗体药物偶联物管理CINV、管理突破性CINV的最合适方法、即使遵循最佳指导仍有CINV的患者的选择、使用低于标准剂量的奥氮平（<10毫克/天）以及管理长期延迟性CINV和接受口服治疗患者的CINV。通过识别更新后的MASCC/ESMO指南中当前的空白并讨论现有证据，我们旨在解决这些问题，并支持可能在临床实践中遇到这些问题的肿瘤学家。需要考虑这些问题以及其他问题，以帮助确保止吐治疗的选择在临床实践中提供最佳效果。
