INNOVATIONS IN ANTIEMETICS IN PEDIATRIC ONCOLOGY: BEYOND THE GUIDELINES

摘要

Some of the traditional agents for chemotherapy-induced nausea and vomiting (CINV) management in children include dopamine antagonists (metoclopramide), corticosteroids (dexamethasone), 5-HT3 antagonists (ondansetron, granisetron), benzodiazepines for anticipatory nausea (lorazepam), antihistamines (diphenhydramine, hydroxyzine), and cannabinoids (dronabinol). Despite major advances in pharmacotherapy of CINV in the last two decades, optimal emetic control in children is yet to be found. Multinational Association of Supportive Care in Cancer (MASCC) and the American Society of Clinical Oncology (ASCO) developed evidence-based guidelines for prevention of CINV in children. Current guidelines recommend the use of 5-HT3 antagonist plus a corticosteroid to prevent acute emesis in children receiving moderately to highly emetogenic chemotherapy. However, these guidelines are limited by lack of robust evidence and lack of recommendations for alternative agents in pediatric patients failing to respond adequately to treatment.