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Chapter 42. Nausea and Vomiting

MR is a 42-year-old woman diagnosed with stage 2 breast cancer. Past medical history is significant for heavy alcohol use. She is single and has no children. She presents to clinic today to begin treatment with doxorubicin and cyclophosphamide.

Select which antiemetic combination will give MR optimal prevention of acute and delayed CINV?

a. Aprepitant, prochlorperazine, and dexamethasone

b. Fosaprepitant, dolasetron, and prochlorperazine

c. Netupitant/palonosetron and haloperidol

d. Rolapitant, palonosetron, and dexamethasone

Answer d is correct. The doxorubicin and cyclophosphamide regimen is categorized as a highly emetic regimen. Rolapitant is FDA-approved to be given in combination with a corticosteroid (dexamethasone) and 5-HT3 receptor antagonist (palonosetron) to prevent acute and delayed CINV with highly emetic regimens.

Answer a is incorrect. Aprepitant is FDA-approved in combination with a corticosteroid (dexamethasone) and 5-HT3 receptor antagonist to prevent acute and delayed CINV with highly emetic regimens. This combination lacks the 5-HT3 receptor antagonist.

Answer b is incorrect. Fosaprepitant is FDA-approved in combination with a corticosteroid and 5-HT3 receptor antagonist (dolasetron) to prevent acute and delayed CINV with highly emetic regimens. This combination lacks the corticosteroid.

Answer c is incorrect. Netupitant/palonosetron (NEPA) is FDA-approved in combination with a corticosteroid to prevent acute and delayed CINV with highly emetic regimens. This combination lacks the corticosteroid.

MR is a 42-year-old woman diagnosed with stage 2 breast cancer. Past medical history is significant for heavy alcohol use. She is single and has no children. She presents to clinic today to begin treatment with doxorubicin and cyclophosphamide.

You note that MR is appropriately treated for acute CINV, but not delayed CINV. Her day 1 regimen includes ondansetron, dexamethasone, and fosaprepitant 150 mg IV prior to chemotherapy. What is the best regimen to prevent delayed CINV for MR?

a. Dexamethasone 8 mg po daily on days 2 through 4

b. Dexamethasone 8 mg po daily on day 2 and 8 mg bid on days 3 and 4

c. Ondansetron 8 mg po bid and dexamethasone 8 mg po daily on day 2 and 8 mg bid on days 3 and 4

d. No treatment is needed as MR is not at risk for delayed nausea and vomiting

Answer b is correct. Only dexamethasone should be continued when fosaprepitant 150 mg IV is used prior to chemotherapy. The recommended dose is 8 mg daily on day 2 and 8 mg bid on days 3 and ...

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