2023 updated MASCC/ESMO consensus recommendations: prevention of nausea and vomiting following high-emetic-risk antineoplastic agents
MASCC/ESMO · 2023 · Europe
Source and licence
- Authors
- Jørn Herrstedt, L Celio, PJ Hesketh et al.
- Title
- 2023 updated MASCC/ESMO consensus recommendations: prevention of nausea and vomiting following high-emetic-risk antineoplastic agents
- Journal
- Supportive Care in Cancer, 2023
- Licence
- CC BY 4.0
- Changes
- Verbatim excerpts; formatting adapted
Full text retrieved 2026-10-27 from Europe PMC · PMC10739516
Licence statement of the original publication
Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
This page reproduces excerpts of the original publication; the original is authoritative. It has not been reviewed by a physician, does not state a recommendation of Medelix and does not replace medical advice. The guideline may have been updated since.
Open the original publication →Full text on Europe PMC
Recommendations
Verbatim, with grade of recommendation or strength of consensus where given.
Discussion
- A four-drug regimen including single doses of a 5-HT3 receptor antagonist, dexamethasone (DEX), an NK1 receptor antagonist (aprepitant, fosaprepitant, netupitant*, fosnetupitant* or rolapitant), and olanzapine given before chemotherapy is recommendedLevel of evidence: I; Grade of recommendation: A
- In patients receiving non-AC HEC treated with a combination of a 5-HT3 receptor antagonist, DEX*, an NK1 receptor antagonist**, and olanzapine to prevent acute nausea and vomiting, DEX and olanzapine on days 2 to 4 is suggested to prevent delayed nausea and vomiting (see note about DEX dosing)Level of evidence: II; Grade of recommendation: B
- In women treated with AC-based chemotherapy, a four-drug regimen including single doses of a 5-HT3 receptor antagonist, DEX, an NK1 receptor antagonist (aprepitant, fosaprepitant, netupitant*, fosnetupitant* or rolapitant), and olanzapine given before chemotherapy is recommendedLevel of evidence: I; Grade of recommendation: A
- In women treated with a combination of a 5-HT3 receptor antagonist, DEX, an NK1 receptor antagonist*, and olanzapine to prevent acute nausea and vomiting, olanzapine on days 2 to 4 is suggested to prevent delayed nausea and vomitingLevel of evidence: II; Grade of recommendation: B
- The best investigated dose is 10 mg. 5 mg is superior to placebo, but it is unknown if it is as effective as 10 mg, because no robust studies have compared the 5 mg and 10 mg doses. The only schedule investigated is once daily for 4 days (see note about sedation)Level of evidence: II; Grade of recommendation: B
Abstract
Purpose: This systematic review updates the MASCC/ESMO recommendations for high-emetic-risk chemotherapy (HEC) published in 2016–2017. HEC still includes cisplatin, carmustine, dacarbazine, mechlorethamine, streptozocin, and cyclophosphamide in doses of > 1500 mg/m2 and the combination of cyclophosphamide and an anthracycline (AC) in women with breast cancer.
Methods: A systematic review report following the PRISMA guidelines of the literature from January 1, 2015, until February 1, 2023, was performed. PubMed (Ovid), Scopus (Google), and the Cochrane Database of Systematic Reviews were searched. The literature search was limited to randomized controlled trials, systematic reviews, and meta-analyses.
Results: Forty-six new references were determined to be relevant. The main topics identified were (1) steroid-sparing regimens, (2) olanzapine-containing regimens, and (3) other issues such as comparisons of antiemetics of the same drug class, intravenous NK1 receptor antagonists, and potentially new antiemetics. Five updated recommendations are presented.
Conclusion: There is no need to prescribe steroids (dexamethasone) beyond day 1 after AC HEC, whereas a 4-day regimen is recommended in non-AC HEC. Olanzapine is now recommended as a fixed part of a four-drug prophylactic antiemetic regimen in both non-AC and AC HEC. No major differences between 5-HT3 receptor antagonists or between NK1 receptor antagonists were identified. No new antiemetic agents qualified for inclusion in the updated recommendations.
Contents of the original publication
The section headings of the original.
- Introduction
- Methods
- Results
- Steroid-sparing regimens
- Olanzapine-containing regimens
- Other issues
- Discussion
A question about this guideline?
Medelix answers clinical questions from guidelines and studies – every statement with its source.
Are you the rights holder and object to this reproduction? Write to contact@medelix.ai and we will take the page down promptly. Imprint