Background At our hospital, the oncology pharmacist participates in the development and implementation of the antiemetic protocol for controlling chemotherapy-induced nausea and vomiting (CINV), evaluates patients’ risk factors and dispenses the antiemetic treatment, and assesses the antiemetic response and optimising antiemetic therapy.
Purpose The aim of this study was to assess the effectiveness of the pharmacist-driven antiemetic prophylaxis in patients undergoing high emetogenic chemotherapy (HEC).
Material and methods We analysed data from patients starting HEC (cisplatin-based chemotherapy or anthracycline/cyclophosphamide combination [AC]).
We have considered the percentage of patients achieving complete response (CR: no vomiting and no rescue) and complete control (CC: CR and no significant nausea), during 0 to 120 hours after chemotherapy administration. We have also calculated the percentage of patients achieving CR and CR after treatment failure and therapy optimisation. CINV were evaluated using a semi-structured clinical interview at every cycle and registering the patient-reported outcomes.
At our hospital, the antiemetic prophylaxis consists of granisetron 1 mg/dexamethasone 20 mg before chemotherapy on day 1, followed by dexamethasone 8–0–4 mg plus metoclopramide 10 mg every 8 hours on days 2 to 4 (squeme A). In patients not achieving CR or CC, we use netupitant/palonosetron (300/0.5 mg)/dexamethasone 12 mg before chemotherapy, dexamethasone 8 mg plus metoclopramide 10 mg every 8 hours on days 2 to 4.
Results The study included 56 patients receiving 206 chemotherapy cycles (71.4% AC, 28.6% cisplatin-based chemotherapy). Seventy-three per cent of patients completed at least three cycles. Ninety-three per cent of patients started antiemetic prophylaxis with squeme A.
Overall CR and CC rates were high and improved over the first three cycles of chemotherapy after treatment optimisation according to clinical response.
34% of patients required some change in the antiemetic treatment used as first line, which led to CR plus CC in 69% of them.
Conclusion Our antiemetic protocol and a close patient follow-up conducted by the oncology pharmacist led to a good control of HEC-induced nausea and vomiting, that improved during the subsequent cycles after an individualised adjustment of the antiemetic treatment according to the patient-reported outcome.
Reference and/or Acknowledgements 1. Gralla RJ, et al. Ann Oncology2014Jul;25(7):1333–1339.
Conflict of interest Corporate-sponsored research or other substantive relationships:
I have participated in a Delphi method supports by Vifor Pharma.
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