Efficacy and safety of 5HT3RA, DEX, and NK1RA for the prevention of FOLFIRINOX-induced nausea and vomiting in patients with pancreatic cancer: a retrospective cohort study

Going beyond the 2023 MASCC and ESMO guideline update for the prevention of chemotherapy- and radiotherapy-induced nausea and vomiting

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.

Antitumoral Agent-Induced Constipation: A Systematic Review

BACKGROUND

Constipation is a common symptom in patients receiving antitumoral treatment. The mechanisms underlying antitumoral agent-induced constipation (ATAIC) are poorly defined. This systematic review aimed to analyze and synthesize the available information related to the prevalence, etiology, and treatment of ATAIC.

METHODS

A systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines was conducted. The review included human studies written in English, French, or Spanish involving patients with cancer and containing information about the prevalence, etiology, and treatment of ATAIC.

RESULTS

A total of 73 articles were included. The reported prevalence ranged from 0.8% to 86.6%. Six studies reported an ATAIC prevalence of over 50%. The prevalence rates of constipation of grades 3 and 4 ranged between 0 and 11%. The importance of enteric neuronal integrity in gastrointestinal function was reported. The articles with the highest levels of evidence in relation to ATAIC treatment obtained in this systematic review studied treatments with acupuncture, sweet potato, osteopath, probiotics, and moxibustion.

CONCLUSIONS

The prevalence of constipation in patients undergoing antitumoral treatment is very diverse. Studies specifically designed to report the prevalence of antineoplastic treatment-induced constipation are needed. The importance of enteric neuronal integrity in gastrointestinal function was described. Thus, neuroprotection could be an area of research for the treatment of chemotherapy-induced gastrointestinal disorders.