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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 (PMH) is significant for severe nausea and vomiting with pregnancy. She is married with two children. She presents to clinic today to begin treatment with doxorubicin and cyclophosphamide. Which of the following risk factors does MR have for developing nausea and vomiting? Select all that apply.

a. Age

b. Female gender

c. Nausea and vomiting with pregnancy

d. Stage 2 breast cancer

Answer a is correct. Patients younger than 50 years are more susceptible to nausea and vomiting.

Answer b is correct. Female patients tend to have more nausea and vomiting than male patients.

Answer c is correct. Patients with a history of nausea and vomiting with pregnancy have an increased risk of chemotherapy-induced nausea and vomiting (CINV).

Answer d is incorrect. Stage 2 breast cancer does not increase the risk of nausea and vomiting.

MR is a 42-year-old woman diagnosed with Stage 2 breast cancer. Past medical history (PMH) is significant for severe nausea and vomiting with pregnancy. She is married with two 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 chemotherapy-induced nausea and vomiting (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 (PMH) is significant ...

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