ASCO NCCN
Four-drug combination
5-HT3 RA plus NK1 RA plus Dex plus
olanzapine Option A:
5-HT3 RA plus NK1 RA plus Dex
Option B:
5-HT3 RA plus NK1 RA plus Dex
plus olanzapine
Option C:
Olanzapine plus palonosetron plus
Dex
5-HT3 RA plus Dex Option A:
5-HT3 RA plus Dex
Option B:
5-HT3 RA plus NK1 RA plus Dex
Option C:
olanzapine plus palonosetron plus
Dex
Carboplatin-treated patients
5-HT3 RA plus NK1 RA plus Dex
Single dose antiemetic, such as Dex
or 5-HT3 RA Single dose antiemetic, such as Dex
or 5-HT3 RA; metoclopramide or
prochlorperazine
No routine prophylaxis No routine prophylaxis
6 Guidelines only make
recommendations for the first
cycle of treatment.
Table 1 shows selective
recommendations of the key
guidelines regarding management
of acute CINV.
There are also some subtle
differences across guidelines in
managing delayed CINV, depending on what is recommended each
time for acute CINV management.
The latest guidelines across
societies highlight more the role
of olanzapine as an effective
antiemetic, although sedation is
also highlighted as a problem for
some patients. Olanzapine is an
atypical antipsychotic and is used
off-label for CINV management.
hospitalpharmacyeurope.com | 2018 | 19