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Supportive Care in Cancer
Published in: Supportive Care in Cancer 12/2021

01-12-2021 | Nausea | Special Article

MASCC antiemetics in advanced cancer updated guideline

Authors: Mellar Davis, David Hui, Andrew Davies, Carla Ripamonti, Andreia Capela, Giulia DeFeo, Egidio Del Fabbro, Eduardo Bruera

Published in: Supportive Care in Cancer | Issue 12/2021

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Abstract

Background

Nausea and vomiting are a common clinical symptom in the advanced cancer patient. Pharmacologic management is important. Evidence for drug choices and guidelines are needed to help clinicians manage nausea and vomiting in this population

Methods

Evidence from a systematic review published in 2010, initial MASCC guidelines developed from a systematic review of literature to 2015, and a new systematic review of randomized trials published between 2015 and February 2, 2021, was combined to establish a new guideline.

Results

A search of the literature between 2015 and February 2, 2021, revealed 257 abstracts of which there was one systematic review and 4 randomized trials which were used to modify the guideline. The new guideline is as follows: First Line: Metoclopramide (II) multiple small RCTs including a placebo-controlled trial, haloperidol (II) multiple non-placebo-controlled RCTs, high consensus. Second line: Methotrimeprazine (II) 1 well-powered non-placebo-controlled RCT, olanzapine (II) 1 placebo-controlled pilot RCT, high consensus. Third line: Tropisetron (II) large unblinded lower quality non-placebo-controlled RCT, levosulpiride (II) 1 blinded non-placebo-controlled pilot RCT, high consensus.

Discussion

Haloperidol, metoclopramide, methotrimeprazine, olanzapine tropisetron, and levosulpiride have been antiemetics used in randomized trials with antiemetic activity demonstrated. There are only three placebo-controlled randomized trials we could find in our literature review. Placebo responses varied significantly between two randomized trials. More randomized placebo-controlled trials with either metoclopramide or haloperidol rescue are needed to clarify antiemetic choices in advanced cancer.

Conclusion

First-line antiemetics for nausea and vomiting in advanced cancer are metoclopramide and haloperidol, and second-line medications are methotrimeprazine and olanzapine.
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Metadata
Title
MASCC antiemetics in advanced cancer updated guideline
Authors
Mellar Davis
David Hui
Andrew Davies
Carla Ripamonti
Andreia Capela
Giulia DeFeo
Egidio Del Fabbro
Eduardo Bruera
Publication date
01-12-2021
Publisher
Springer Berlin Heidelberg
Published in
Supportive Care in Cancer / Issue 12/2021
Print ISSN: 0941-4355
Electronic ISSN: 1433-7339
DOI
https://doi.org/10.1007/s00520-021-06437-w

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