PREVENTION OF CHEMOTHERAPY-INDUCED AND RADIOTHERAPY-INDUCED EMESIS - RESULTS OF THE PERUGIA CONSENSUS CONFERENCE

Background. The need to review and summarize the evidence concerning p reventive treatment of cancer chemotherapy- and radiotherapy-induced e mesis. Design: After a survey among experts the Antiemetic Subcommitte e of the MASCC planned and held a Consensus Conference on antiemetic t herapy. Recommendations were provided on the basis of scientific confi dence and the level of consensus among the participating experts. Resu lts and conclusions: A 5-HT3 antagonist plus dexamethasone is the regi men of choice in the prevention of acute emesis induced by single high , and low and repeated doses of cisplatin, and of acute emesis induced by moderately-high emetogenic chemotherapy (i.e., cyclophosphamide, d oxorubicin, epirubicin, carboplatin, used alone or in combination) in both adults and children. In the prevention of delayed emesis induced by cisplatin the most efficacious choice is a combination of dexametha sone with either metoclopramide or a 5-HT3 antagonist, while in modera tely-high emetogenic chemotherapy dexamethasone alone or a 5-HT3 antag onist alone or their combination should be used. No evidence or consen sus exists regarding antiemetic treatment for patients receiving low e metogenic chemotherapy, or about the optimal rescue treatment for pati ents failing antiemetic prophylaxis. The best treatment for anticipato ry emesis is the best possible control of acute and delayed emesis. Al though 5-HT3 antagonists have some efficacy in the prevention of acute emesis induced by high-dose chemotherapy, more studies should be carr ied out to determine the best preventive treatment. For prevention of acute emesis induced by highly/moderately emetogenic radiotherapy (TBI , irradiation of the upper part of the abdomen or of the whole abdomen /radiotherapy of the thorax, pelvis and lower body half) a 5-HT3 antag onist is the best choice.