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1
Optimal duration of therapy (at least 72 h)
Aprepitant plus DEX and an anti-5HT3 is
beneficial in the prevention of N/V by HEC
Apr. DEX vs DEX anti-5HT3
Apr. DEX vs DEX metocl.
Cost-effectiveness1
What dosage for DEXA?
QoL
Apr. control of NAUSEA and nausea as
related AE2
Dosage of DEXA (20 vs 12)
Cost-effectiveness1
Palonosetron ? from the other anti5HT3?3
2
Antiemetic profilaxis
Anti 5HT3 plus DEXA is beneficial in the
prevention of N/V by most MEC
is mandatory
Oral DEXA is the preferred tx
What efficacy for anti5HT3?
Addition of aprepitant is more effective than
the control regimen in pts receiving AC/EC1
Aprepitant plus DEXA superior to DEXA?
(Women in the control arm receveid
ondansetron!)
Aprepitant only for AC/EC?
Dose and duration for DEXA

PALO superior to the other anti-5HT3? (Pts did
not receive DEXA in the first 24 h!)2,3
Palonosetron vs the other anti5HT3? In d2-4 pts
did not receive DEXA or anti5HT3 or metocl.!2,3
3
Pts who receive low/minimal risk CT should NOT
receive profilaxis for delayed emesis
No profilaxis for acute emesis from minimal risk
CT
What about new schedules? (p.e. weekly
taxanes) What about new drugs? (p.e. oral
antiblastics, molecular-targeted agents)
Corticosteroid for low risk CT? (different
indications in ASCO and MASCC LG) Which one?
What dosage and duration?

No ? between acute and delayed emesis for agents
given orally for weeks/months1
No studies with clear assessment
of their emetogenicity1
4
And what about..?

• The role of benzodiazepines (lorazepam)

Action anxiolytic amnestic antiemetic
(unknown mechanism) General acceptance about
their efficacy in anticipatory emesis ASCO
and NCCN GL mention lorazepam as a useful
addition in acute and delayed emesis too
MASCC GL do not..

• Unavailability in some countries of oral DEXA or
  of oral DEXA
• in appropriate dosage formulation. May
  prednisone 25 mg bid be
• a reasonable alternative?

• Interference of aprepitant with the metabolism of
  many drugs
• and some cytotoxics (taxanes, vinca alkaloids,
  etoposide).
• Risk of more frequent clinical adverse events?