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Proffered paper session - Supportive and palliative care

3439 - Evaluation of practice patterns for prevention of chemotherapy (CT)-induced nausea and vomiting (CINV) and antiemetic guidelines (GLs) adherence based on real-world prescribing data


21 Oct 2018


Proffered paper session - Supportive and palliative care


Management of Systemic Therapy Toxicities;  Cytotoxic Therapy;  Supportive Care and Symptom Management

Tumour Site


Matti Aapro


Annals of Oncology (2018) 29 (suppl_8): viii603-viii640. 10.1093/annonc/mdy300


M.S. Aapro1, F. Scotté2, Y. Escobar3, L. Celio4, R.D. Berman5, A. Franceschetti6, D. Bell7, K. Jordan8

Author affiliations

  • 1 Genolier Cancer Centre, Clinique de Genolier, 1272 - Genolier/CH
  • 2 Medical Oncology And Supportive Care Department, Foch Hospital, 92151 - Suresnes/FR
  • 3 Department Of Medical Oncology, Hospital General Universitario Gregorio Marañón, 28007 - Madrid/ES
  • 4 Department Of Medical Oncology And Hematology, Fondazione IRCCS - Istituto Nazionale dei Tumori, 20133 - Milan/IT
  • 5 -, The Christie NHS Foundation Trust, M20 4BX - Manchester/GB
  • 6 -, Ipsos MORI, E1W 1WY - London/GB
  • 7 -, Ipsos Healthcare, 07430 - Mahwah/US
  • 8 Department Of Medicine V, Hematology, Oncology And Rheumatology, University Hospital of Heidelberg, 69120 - Heidelberg/DE


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Abstract 3439


GLs-recommended antiemetic treatment improves emesis in most patients (pts) receiving CT. Non-adherence to GLs leads to suboptimal CINV control. MASCC/ESMO GLs recommend prophylaxis with a neurokinin-1 receptor antagonist (NK1RA), a 5-hydroxytryptamine-3 (5-HT3) RA, and dexamethasone (DEX) for pts receiving highly emetogenic CT (HEC, including anthracycline-cyclophosphamide [AC]) and carboplatin-based regimens. Here, we analyse use of NK1RA + 5-HT3RA + DEX for antiemetic prophylaxis prior to HEC and carboplatin (considered moderately EC [MEC]).


The data source was the Global Oncology Monitor (Ipsos Healthcare). Geographically representative physicians from France, Germany, Italy, Spain, and UK were screened for treatment involvement and number of pts treated/month. Pts’ data from Jan–Dec 2017 were collected and extrapolated based on a doctor universe; projected estimates are shown here. The emetic risk of CT was classified per MASCC/ESMO GLs.


Antiemetic treatment use is shown (Table). Data from 46,503 pts treated with CT were collected, which represents a total prevalence of 1,468,522 CT-treated pts included in the analysis. NK1RAs were used in 39%/36%/23% of pts receiving cisplatin-/AC-/carboplatin-based CT, respectively; 18%/20%/11% received the GLs-recommended NK1RA + 5-HT3RA + DEX combination; 17% of all HEC-/MEC-treated pts received no antiemetics. Physicians’ perception of the emetic risk of CT did not follow MASCC/ESMO GLs classification for 48%/48%/43% of cisplatin-/AC-/carboplatin-based regimens.Table: 1681O

Use of NK1RA-based prophylactic antiemetic treatments for CINV by emetic risk of chemotherapy according to the MASCC/ESMO guidelines classification

Chemotherapy regimenTotal patients,* %, nPatients with NK1RAs,* %, nNK1RA + 5-HT3 RA + DEX, %NK1RA  + 5-HT3RA, %NK1RA + DEX, %NK1RA monotherapy, %NK1RA + other antiemetics, %
HEC – cisplatin based55% of HEC 211,60039% 81,82718% 38,80416% 33,3632% 4,9352% 4,5540% 172
HEC – AC based39% of HEC 151,18536% 54,72420% 30,95512% 18,6012% 3,4971% 1,4190% 252
HEC – other6% of HEC 22,21917% 3,8032% 51513% 2,8941% 1441% 2340% 15
MEC – carboplatin based30% of MEC 177,02723%, 40,31711% 18,83910% 17,4841% 1,9951% 1,6560% 343
Total (all HEC + carboplatin based)38% of all patients 562,03232% 180,67116% 89,11413% 72,3422% 10,5711% 7,8620% 783

5-HT3RA, 5-hydroxytryptamine-3 receptor antagonist; AC, anthracycline-cyclophosphamide; CINV, chemotherapy-induced nausea and vomiting; DEX, dexamethasone; HEC, highly emetogenic chemotherapy; MASCC/ESMO, Multinational Association of Supportive Care in Cancer/European Society for Medical Oncology; MEC, moderately emetogenic chemotherapy; NK1RA, neurokinin-1 receptor antagonist.


Estimate of total number of patients is based on the projected prevalence of total 1,468,522 patients being treated with chemotherapy. A sample of 46,503 patients was used for the projections.


EU practice patterns revealed very low adherence to antiemetic GLs in clinical practice, with 16% of all pts (HEC/AC/carboplatin) receiving an NK1RA + 5-HT3RA + DEX, and 17% of HEC-/MEC-treated pts receiving no antiemetics. New strategies to improve GLs adherence are critically needed.

Clinical trial identification

Legal entity responsible for the study

Helsinn Healthcare.


Helsinn Healthcare.

Editorial Acknowledgement

Editorial and medical writing support was provided by Iratxe Abarrategui, PhD, CMPP, from TRM Oncology, The Hague, The Netherlands, and funded by Helsinn.


M.S. Aapro: Advisor, honoraria: Eisai, Helsinn, Merck, Mundipharma, Tesaro; Research grants: Helsinn, Merck, Tesaro. F. Scotté: Member of advisory boards or speaker: Roche, Amgen, Tesaro, Vifor, MSD, Pierre Fabre Oncology, Leo Pharma, Sanofi, Helsinn, Pfizer. L. Celio: Advisor: Italfarmaco SpA. R.D. Berman: Honoraria for seminars and lectures: Chugai, Tesaro. A. Franceschetti, D. Bell: Employee: Ipsos. K. Jordan: Consultant or received honoraria: Helsinn Healthcare, Tesaro, Merck/MSD. All other authors have declared no conflicts of interest.

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