of antiemetic drugs used, with
potential reductions in costs.
For example, older patients
receiving a high-dose cisplatin
regimen and who present no CINV
risk factors might not need to
receive triple therapy. 5
The benefits of using risk
prediction models to inform
the choice of the appropriate
antiemetic regimen was
demonstrated in a randomised
clinical study involving over 320
patients with early-stage breast
cancer who received a highly
emetogenic chemotherapy
regimen. When patients’ treatment
plans were defined according
to their risk levels (addition of
aprepitant, with or without low-
dose olanzapine, to a standard
combination of dexamethasone
and a serotonin RA for those
at high risk), the frequency of
reported acute and delayed nausea
and vomiting was significantly
reduced versus patients receiving
physician-based choice of
antiemetic prophylactic therapy,
with an associated improvement
in patient quality of life over their
entire course of chemotherapy. 12
The classification of patients
according to risk for CINV might
also enable the identification of
those individuals who may need
further information on how to
control their symptoms, and
potentially contribute to the real-
world assessment of the suitability
of current institutional CINV
treatment protocols. In addition,
patient quality of life might be
improved.
Prediction models and their
utility in the management of
CINV
Risk prediction models
discriminating between high-
risk and low-risk patients can
be valuable complementary
tools in the management of
prevention of CINV side effects.
The development of robust, and
easy to use predictive models,
incorporating multiple variables
and attributing different weights
to each contributing risk factor,
has seen tremendous progress in
the past years. One of the models
developed used data from 200
patients enrolled in a prospective
cohort study to derive a cycle-based
algorithm for moderate/severe
acute CINV. 13 Another cycle-
based model was able to predict
the risk of moderate-to-severe
delayed CINV manifestations
in spite of use of conventional
antiemetic prophylaxis protocols,
but included only a small number
of patients with haematologic
malignancies and did not integrate
antiemetic regimens containing
apretitant because this drug was
not commercially available at the
time. 5 A new and improved model
based that can be applied by cycle
of chemotherapy was recently
developed from a large patient
cohort. The intent of the model
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