- Email: [email protected]
Patient risk factors versus physician guidelines for anti-emetics
News
In a phase 3, randomised clinical trial, patient risk factors (eg, age, pregnancy-associated morning sickness, alcohol intake, and travel sickness) might exceed physician guidelines for anti-emetic prescription in management of chemotherapyinduced nausea and vomiting (CINV). “This is the world’s first study to randomise patients between physicians’ choice of anti-emetics and the ones prescribed, according to a mathematical model, that incorporated personal risk factors for emesis”, said lead author Mark Clemons (The Ottawa Hospital Cancer Centre, Ottawa, ON, Canada). Study researchers randomly assigned 324 patients with early-stage breast cancer receiving cyclophosphamide and anthracycline chemotherapy to receive either anti-emetics of their physicians’ choice (standard care group; n=170) or receive different
anti-emetics according to their risk factors (risk model-guided group [RMG]; n=154). Patients deemed low risk for emesis received dexamethasone and a 5-HT3 antagonist, whereas those at high risk also received aprepitant with or without olanzapine, based on risk level. The primary endpoint was patientreported control of nausea and vomiting in the first 24 h (acute period) and 2–5 days (delayed period) after chemotherapy. Compared with the control group, significantly more patients in the RMG group noted better control of their nausea (53·7% [95% CI 49·2–58·1] vs 41·6% [37·4–45·3, p<0·001]) and vomiting (91·8% [95% CI 89·0–94·0] vs 82·2% [78·8–85·3, p<0·001]) in the acute period. Results were similar during the delayed period. “These findings provide personalised anti-emetic prescription as opposed to
the cookie-cutter recommendations that do not take personal risks into account”, said Clemons. He added that their RMG model could be used for other cancer types. Justin Stebbing (Imperial College London, London, UK) commented “We may not be able to readily apply these findings in clinic; [however,] this work reminds us that we must continue to optimise control of treatment-induced side-effects, and arrive at optimal personalised management for CINV”. However, in a linked comment, David Warr (Princess Margaret Cancer Centre, Toronto, ON, Canada) and co-authors stated that the study’s “classification scheme [was] not accurate“ and were sceptical whether clinicians would spend time extracting and calculating patients’ risks of emesis.
Amelie-Benoist/BSIP/Corbis
Patient risk factors versus physician guidelines for anti-emetics
Lancet Oncol 2015 Published Online November 19, 2015 http://dx.doi.org/10.1016/ S1470-2045(15)00536-7 For the study by Clemons and colleagues see http://oncology. jamanetwork.com/article. aspx?articleid=2469339
Vijay Shankar Balakrishnan
www.thelancet.com/oncology Published online November 19, 2015 http://dx.doi.org/10.1016/S1470-2045(15)00536-7
1
In a phase 3, randomised clinical trial, patient risk factors (eg, age, pregnancy-associated morning sickness, alcohol intake, and travel sickness) might exceed physician guidelines for anti-emetic prescription in management of chemotherapyinduced nausea and vomiting (CINV). “This is the world’s first study to randomise patients between physicians’ choice of anti-emetics and the ones prescribed, according to a mathematical model, that incorporated personal risk factors for emesis”, said lead author Mark Clemons (The Ottawa Hospital Cancer Centre, Ottawa, ON, Canada). Study researchers randomly assigned 324 patients with early-stage breast cancer receiving cyclophosphamide and anthracycline chemotherapy to receive either anti-emetics of their physicians’ choice (standard care group; n=170) or receive different
anti-emetics according to their risk factors (risk model-guided group [RMG]; n=154). Patients deemed low risk for emesis received dexamethasone and a 5-HT3 antagonist, whereas those at high risk also received aprepitant with or without olanzapine, based on risk level. The primary endpoint was patientreported control of nausea and vomiting in the first 24 h (acute period) and 2–5 days (delayed period) after chemotherapy. Compared with the control group, significantly more patients in the RMG group noted better control of their nausea (53·7% [95% CI 49·2–58·1] vs 41·6% [37·4–45·3, p<0·001]) and vomiting (91·8% [95% CI 89·0–94·0] vs 82·2% [78·8–85·3, p<0·001]) in the acute period. Results were similar during the delayed period. “These findings provide personalised anti-emetic prescription as opposed to
the cookie-cutter recommendations that do not take personal risks into account”, said Clemons. He added that their RMG model could be used for other cancer types. Justin Stebbing (Imperial College London, London, UK) commented “We may not be able to readily apply these findings in clinic; [however,] this work reminds us that we must continue to optimise control of treatment-induced side-effects, and arrive at optimal personalised management for CINV”. However, in a linked comment, David Warr (Princess Margaret Cancer Centre, Toronto, ON, Canada) and co-authors stated that the study’s “classification scheme [was] not accurate“ and were sceptical whether clinicians would spend time extracting and calculating patients’ risks of emesis.
Amelie-Benoist/BSIP/Corbis
Patient risk factors versus physician guidelines for anti-emetics
Lancet Oncol 2015 Published Online November 19, 2015 http://dx.doi.org/10.1016/ S1470-2045(15)00536-7 For the study by Clemons and colleagues see http://oncology. jamanetwork.com/article. aspx?articleid=2469339
Vijay Shankar Balakrishnan
www.thelancet.com/oncology Published online November 19, 2015 http://dx.doi.org/10.1016/S1470-2045(15)00536-7
1