Nausea and Vomiting after Chemotherapy for Breast Cancer: New ASCO Guidelines on Prevention

Nausea and vomiting are perhaps the most unpleasant potential side effects of chemotherapy for breast cancer. Last week the American Society of Clinical Oncology (ASCO) updated its practice guidelines for the prevention of nausea and vomiting. Today, we'll highlight the latest recommendations.

Links to the new guidelines published in the Journal of Clinical Oncology, a DoctorsChannel.com video about the update and a Los Angeles Times story on the start of preventative medication may be found on the Aloxi (palonosetron) page of our website.

Adriamycin/Cytoxan and Ellence/Cytoxan combinations have a high risk

The ASCO guidelines classify chemotherapy drugs and combinations according to the likelihood that they may cause nausea and vomiting. Individually, Adriamycin (doxorubicin), Ellence (epirubicin) and lower dose Cytoxan (cyclophosphamide) are considered to have a moderate risk of causing nausea and vomiting. Under the new guidelines, the Adriamycin/Cytoxan and Ellence/Cytoxan combinations are considered to have a high risk, meaning they are very likely to cause nausea and vomiting.

Three drug combination for chemotherapy with a high risk

For chemotherapy drugs with a high risk of causing nausea and vomiting, such as the combinations above, Platinol (cisplatin) and high dose Cytoxan, the guidelines recommend a three drug combination:

EMEND (aprepitant) or EMEND for Injection (fosaprepitant) . Because EMEND for Injection is administered for 1 day rather than 3, it may be preferable.

plus

Aloxi (palonosetron). If Aloxi is not available, Kytril (granisetron) or Zofran (odansetron) may be substituted.

plus

dexamthasone.

Two drug combination for chemotherapy with a moderate risk

For chemotherapy with a moderate risk of causing nausea and vomiting, such as Camptosar (irinotecan), Paraplatin (carboplatin) or Adriamycin, Ellence or low dose Cytoxan alone, the ASCO recommends a two drug combination of dexamethasone plus Aloxi. The report notes that there is "moderate evidence" suggesting that EMEND may add benefit.

One drug for chemotherapy with a low risk

For chemotherapy with a low risk of causing nausea and vomiting, such as Taxotere (docetaxel), 5-FU (fluorouracil), Gemzar (Gemcitabine), methotrexate, Torisel (temsirolimus) and Ixempra (ixabepilone), the ASCO recommends a single dose of dexamethasone.

According to an October 3 article in the Los Angeles Times, it's not unusual to start taking medication to prevent nausea before the start of chemo.

A September 26 What to Know guide from ASCO provides a patient-friendly summary of the ASCO guidelines, including a classification of chemotherapy drugs by risk of nausea and vomiting.

At LATESTBreastCancer.com, we'll continue to follow research on the prevention of nausea and vomiting related to chemotherapy for breast cancer. Any new developments will be added to the treatment pages of our website and highlighted here. Please stay tuned.

The Breast Cancer News Update: July 25

Today in breast cancer research news, we'll look at recent studies on Herceptin plus chemotherapy and Ellence plus Taxotere for early breast cancer, the Doxil shortage, and a study on the risk of recurrence after a trauma or surgery. Links to the study abstracts may be found on the treatment pages of the LATESTBreastCancer.com website.

Herceptin benefits confirmed in long-term follow-up

In 2006, Herceptin (trastuzumab) received FDA approval in combination with chemotherapy for the treatment of early, HER2 positive breast cancer based on two large trials - the North Central Cancer Treatment Group (NCCTG) and National Surgical Adjuvant Breast and Bowel Project (NSABP). This week, a Journal of Clinical Oncology study published four-year follow-up data which confirmed the benefit of Herceptin. Consistent disease-free survival and overall survival advantages were observed during "the longest follow-up reported to date." "The clinical benefits continue to outweigh the risks of adverse effects."

Ellence followed by Taxotere is better than Ellence alone

Chemotherapy drugs may be given alone or in combination with other chemotherapy drugs. This week, a "relatively small" phase III trial in the Journal of Clinical Oncology compared survival, toxicity and quality of life of six cycles of Ellence (epirubicin) alone to three cylces of Ellence followed by three cycles of Taxotere (docetaxel) for women with postmenopausal, node-positive, early breast cancer. Both disease-free survival and five-year survival rates were better in the Ellence plus Taxotere arm. Ellence plus Taxotere was associated with "greater toxicity," but there was no difference in quality of life during follow-up.

TheDoctorsChannel.com published a detailed video on this study for medical professionals. A link to the video may be found under the news tab on the Taxotere page of the LATESTBreastCancer.com website.

Chemotherapy drug Doxil is in short supply

Doxil (PLD), a chemotherapy approved for ovarian cancer, is in clinical trial or used off-label for breast cancer. It's a formulation of Adriamycin (doxorubicin) believed to reduce its cardiotoxicity, or heart-related side effects. According to Reuters, Johnson & Johnson has announced a Doxil shortage and advised doctors not to start new patients on Doxil. New supplies will not be shipped until late August.

Trauma or surgery after breast cancer not associated with increased risk of recurrence

According to a recent Annals of Oncology study, "Several lines of evidence suggest that cytokines released as a result of wound healing might reactivate dormant breast cancer metastases." To test this, British researchers examined recurrence rates 2 to 24 months after a non-cancer related trauma or surgery. They concluded that "[t]rauma was not associated with an increased rate of breast cancer recurrence in the 24-month window after the event in this large study." (Emphasis added.)

Please check back tomorrow for more breast cancer research news updates. Until then, all the latest news and research on any breast cancer test or treatment option may be found on our website anytime.