MASCC guide slides060804 1st ed by Ax4F0n

VIEWS: 10 PAGES: 44

									               PERUGIA INTERNATIONAL CANCER
                      CONFERENCE VII
      MULTINATIONAL ASSOCIATION FOR SUPPORTIVE
                   CARE IN CANCER

          CONSENSUS CONFERENCE ON ANTIEMETIC THERAPY
                    PERUGIA, March 29-31, 2004


                          Organizing and Overall Meeting Chairs:
                                   Richard J. Gralla, MD
                                     Fausto Roila, MD
                                   Maurizio Tonato, MD


Multinational Association for Supportive Care in Cancer            June 2004
                These slides are provided to all by the
            Multinational Association for Supportive Care
            in Cancer and can be used freely provided no
             changes are made, and the MASCC logo and
                 date of the information are retained.


                                       For questions please contact:
                       Cynthia Rittenberg - cindyrit@bellsouth.net




Multinational Association for Supportive Care in Cancer                June 2004
                      ANTIEMETIC GUIDELINE CONSENSUS
                                - A few comments on this guideline set -

 • This set of guideline slides represents the first edition of the
      guideline process from the Perugia meeting.

 • This set of panels has been endorsed by the MASCC antiemetic
      guideline committee, as of June 1, 2004.

        Other guideline groups involved in the Perugia process will issue
            their guidelines according to each organization’s process

 • These findings DO NOT reflect the reports from ASCO 2004, or
      MASCC 2004.

        Results from studies presented at these meetings…both in June
            2004, will be discussed by the guideline groups (see information
            on the ongoing process) and will affect the next edition of the
            guidelines, later in 2004
             • These meetings may have the greatest effect on guidelines
                concerning the use of aprepitant or palonosetron
Multinational Association for Supportive Care in Cancer                    June 2004
                   ANTIEMETIC GUIDELINE CONSENSUS


  - Official Process Subscribed to by 9 International Oncology Groups -


    International:                                        MASCC

    North America:
          - U.S.                                          ASCO, ONS, NCCN
          - Canada                                        CCO

    Europe:                                               ESMO, EONS
    Africa:                                               SASMO
    Australia:                                            COSA


Multinational Association for Supportive Care in Cancer                     June 2004
                      PARTICIPANTS IN THE PERUGIA
                   ANTIEMETIC GUIDELINE PROCESS: 2004


 Matti Aapro, MD                                          Jim Koeller, RPh, MS
 Enzo Ballatori, PhD                                      Mark Kris, MD
 Sussanne Borjeson, RN, PhD                               Ernesto Maranzano, MD
 Rebecca Clark-Snow, RN, BSN, OCN                         Alexander Molassiatis, RN, PhD
 Albano Del Favero, MD                                    Ian Olver, MD, PhD
 Lawrence Einhorn, MD                                     David Osoba, MD
 Petra Feyer, MD                                          Bernardo Rapoport, MD
 Richard Gralla, MD                                       Cynthia Rittenberg, RN, MN, AOCN
 Steven Grunberg, MD                                      Fausto Roila, MD
 Jørn Herrstedt, MD                                       Maurizio Tonato, MD
 Paul Hesketh, MD                                         David Warr, MD
 Rolf Kaiser, MD, PhD



Multinational Association for Supportive Care in Cancer                             June 2004
                       PERUGIA 2004 ANTIEMETIC GUIDELINES
                                         - The Process -

 1)      Each committee worked on its area of concentration prior to the
         Perugia Meeting. At Perugia, each committee chair presented the
         findings of that committee to the entire group, and included the
         suggested rating of the level of evidence / confidence of the
         guideline (ASCO and MASCC criteria).
 2)      Group discussion and consensus voting then followed each
         presentation.
      What were the criteria for consensus?
       •      As per a prior consensus meeting*:
                 75% or greater agreement among the panelists was
                 required to change a guideline.
       •      To change an existing guideline:
                 Compelling evidence was required based on well-
                 conducted trials, generally with a comparator felt to be
                 consistent with guidelines and representing best practice.
  * Columbia Consensus antiemetic meeting 2001

Multinational Association for Supportive Care in Cancer                 June 2004
                           PERUGIA 2004 ANTIEMETIC GUIDELINES
                      - Committees and their Areas (1/2) -


 I.        Emetic classification of antineoplastic agents

 II.        Acute emesis: Highly emetic chemotherapy

 III.       Delayed emesis: Highly emetic chemotherapy

 IV.       Acute emesis: Moderately emetic chemotherapy

 IV.       Delayed emesis: Moderately emetic chemotherapy




Multinational Association for Supportive Care in Cancer         June 2004
                           PERUGIA 2004 ANTIEMETIC GUIDELINES
                      - Committees and their Areas (2/2) -


 VI.       Emesis induced by minimal or low emetic risk
           chemotherapy

 VII.      Additional Issues: Refractory emesis, rescue antiemetic
           therapy,multiple-day chemotherapy, high-dose
           chemotherapy

 VIII. Anticipatory emesis

 IX.       Radiotherapy-induced emesis, Antiemetics in children
           receiving chemotherapy

 X.       Future Considerations: Research Directions, Study
          Design, Economic Considerations


Multinational Association for Supportive Care in Cancer           June 2004
                           PERUGIA 2004 ANTIEMETIC GUIDELINES
                                             - Process for the future:
              Keeping the Guidelines Accurate, Up-to-Date, and Valid -


 Ongoing process to address emerging evidence in the future:

       • Committees are permanent
       • Each chair queries the committee every 6 months regarding
         whether there is new information which may affect the guideline
       • A steering committee queries the chairs for these suggestions
       • If evidence appears compelling, all group members are notified
         for their opinions
       • If consensus is achieved, the Web-Guideline document
         (MASCC) is updated. All participating Societies are notified.
       • Future print publications will have to be addressed – this should
         be done in a coordinated way among the Societies



Multinational Association for Supportive Care in Cancer                  June 2004
                           PERUGIA 2004 ANTIEMETIC GUIDELINES




     ANTIEMETIC TREATMENT GUIDELINES
              - Committee I (1/5): The Four Emetic Risk Groups -

                                                          Risk in nearly all
                    HIGH                                  patients (> 90%)
                                                          Risk in 30% to 90% of
                    MODERATE                              patients
                                                          Risk in 10% to 30% of
                    LOW                                   patients

                    MINIMAL                               Fewer than 10% at risk




Multinational Association for Supportive Care in Cancer                            June 2004
                           PERUGIA 2004 ANTIEMETIC GUIDELINES




     ANTIEMETIC TREATMENT GUIDELINES
     - Committee I (2/5): Emetic Risk Groups - Single IV Agents -

                                        Cisplatin
                                        Mechlorethamine
                                        Streptozotocin
HIGH                                    Cyclophosphamide > 1500 mg/m2
                                        Carmustine
                                        Dacarbazine

                                        Oxaliplatin               Doxorubicin
                                        Cytarabine > 1 gm/m2      Daunorubicin
                                        Carboplatin               Epirubicin
MODERATE                                Ifosfamide                Idarubicin
                                        Cyclophosphamide < 1500   Irinotecan
                                        mg/m2


Multinational Association for Supportive Care in Cancer                          June 2004
                           PERUGIA 2004 ANTIEMETIC GUIDELINES




     ANTIEMETIC TREATMENT GUIDELINES
     - Committee I (3/5): Emetic Risk Groups - Single IV Agents -

                                        Paclitaxel        Mitomycin
                                        Docetaxel         Gemcitabine
                                        Mitoxantrone      Cytarabine < 100
                                        Topotecan         mg/m2
LOW                                     Etoposide         5-Fluorouracil
                                        Pemetrexed        Bortezomib
                                        Methotrexate      Cetuximab
                                                          Trastuzumab




Multinational Association for Supportive Care in Cancer                June 2004
                           PERUGIA 2004 ANTIEMETIC GUIDELINES




     ANTIEMETIC TREATMENT GUIDELINES
     - Committee I (4/5): Emetic Risk Groups - Single IV Agents -

                                        Bleomycin
                                        Busulfan
                                        2-Chlorodeoxyadenosine
                                        Fludarabine
Minimal                                 Vinblastine
                                        Vincristine
                                        Vinorelbine
                                        Bevacizumab




Multinational Association for Supportive Care in Cancer          June 2004
                           PERUGIA 2004 ANTIEMETIC GUIDELINES




     ANTIEMETIC TREATMENT GUIDELINES
    - Committee I(5/5): Emetic Risk Groups - Single Oral Agents -

                                       Hexamethylmelamine
      HIGH                             Procarbazine
                                       Cyclophosphamide        Vinorelbine
      MODERATE                         Etoposide               Imatinib
                                       Temozolomide

      LOW                              Capecitabine

                                       Chlorambucil            6-Thioguanine
      MINIMAL                          Hydroxyurea             Methotrexate
                                       L-Phenylalanine mustard Gefitinib


Multinational Association for Supportive Care in Cancer                        June 2004
                                         COMMITTEE II:


 Guideline for the Prevention of Acute Nausea and Vomiting
 Following Chemotherapy of High Emetic Risk:

 To prevent acute vomiting and nausea following chemotherapy
 of high emetic risk, a three-drug regimen including single doses
 of a 5-HT3 antagonist, dexamethasone, and aprepitant given
 before chemotherapy is recommended.

 MASCC Level of Consensus: High
 MASCC Level of Confidence: High

 ASCO Level of Evidence: I
 ASCO Grade of Recommendation: A


Multinational Association for Supportive Care in Cancer       June 2004
                                  COMMITTEE II and IV
        - Principles of Care for Acute Highly and Moderately Emetic Settings -


 UNANIMOUS CONSENSUS: CATEGORY I EVIDENCE
 - Use the lowest tested fully effective dose
 - No schedule is better than a single dose given
    before chemotherapy
 - The antiemetic efficacy and adverse effects of these
    agents are comparable in controlled trials
 - Intravenous and oral formulations are equally effective
     and safe*
 - Always give dexamethasone with a 5-HT3 antagonist
     before chemotherapy


     * Palonosetron has only been investigated as an IV formulation.

Multinational Association for Supportive Care in Cancer                      June 2004
                                         COMMITTEE III:

 Guideline for the Prevention of Delayed Nausea and Vomiting
 Following Chemotherapy of High Emetic Risk:

 In patients receiving cisplatin treated with a combination of
 aprepitant, a 5-HT3 receptor antagonist and dexamethasone to
 prevent acute vomiting and nausea, the combination of
 dexamethasone and aprepitant is suggested to prevent delayed
 emesis, on the basis of its superiority to dexamethasone alone.

 MASCC Level of Consensus: Moderate
 MASCC Level of Confidence: High

 ASCO Level of Evidence: II
 ASCO Grade of Recommendation: A

Multinational Association for Supportive Care in Cancer        June 2004
                                 COMMITTEE IV (1/3):


 Guideline for prevention of acute emesis in moderately
 emetic chemotherapy (MEC):

 A 5-HT3 receptor antagonist plus dexamethasone
 is recommended for prophylaxis of acute nausea
 and vomiting in the first course of MEC.

 MASCC level of confidence: High
 MASCC level of consensus: High

 ASCO level of evidence: I
 ASCO grade of recommendation: A

Multinational Association for Supportive Care in Cancer   June 2004
                                   COMMITTEE IV (2/3):

   Guideline for prevention of acute emesis in moderately
   emetic chemotherapy:

   There are no clinically relevant differences in the effectiveness of the 5-
   HT3 receptor antagonists in the prophylaxis of acute nausea and
   vomiting when given according to guidelines in the first cycle of MEC*.

   MASCC level of confidence: High
   MASCC level of consensus: High

   ASCO level of evidence: I
   ASCO grade of recommendation: A

* Participants felt that the comparative data with palonosetron were interesting, but indicated that studies
with this agent which follow guidelines (given with dexamethasone) are needed to change this guideline.

  Multinational Association for Supportive Care in Cancer                                            June 2004
                                 COMMITTEE IV (3/3):

 Guideline for prevention of acute emesis in moderately
 emetic chemotherapy:

 The recommended dose of dexamethasone for prophylaxis of
 acute nausea and vomiting from MEC is 8 mg intravenously x 1

 MASCC level of confidence: Moderate
 MASCC level of consensus: High

 ASCO level of evidence: II
 ASCO grade of recommendation: B



Multinational Association for Supportive Care in Cancer   June 2004
                Recommended Doses of Serotonin Receptor
                   (5-HT3) Antagonists for Acute Emesis


               AGENT                       ROUTE                    DOSE
                                               IV         8 mg or 0.15 mg / Kg
     Ondansetron
                                             Oral                  16 mg*
                                              IV          1 mg or 0.01 mg / Kg
     Granisetron
                                             Oral            2 mg (or 1 mg**)
                                              IV          100 mg or 1.8 mg / Kg
     Dolasetron
                                             Oral                  100 mg
                                              IV                     5 mg
     Tropisetron
                                             Oral                    5 mg
     Palonosetron                             IV                   0.25 mg
* Randomized studies have tested the 8 mg twice daily schedule
** The 1 mg dose preferred by some panelists: small randomized study in MEC, Phase II study in HEC

Multinational Association for Supportive Care in Cancer                                    June 2004
                         Recommended Dexamethasone and
                               Aprepitant Dosing

            DEXAMETHASONE                                         Dose and Schedule
                        - Acute Emesis                                  20 mg once
 High Risk
                        - Delayed Emesis                          8 mg bid for 3 - 4 days

                        - Acute Emesis                                   8 mg once
 Moderate
 Risk                                                            8 mg daily for 2 - 3 days
                        - Delayed Emesis
                                                          (many panelists give the dose as 4 mg bid)

 Low Risk               - Acute Emesis                                 4 - 8 mg once

                   APREPITANT                                       Dose and Schedule

     - Acute Emesis                                                 125 mg orally, once

     - Delayed Emesis                                          80 mg orally, once for 2 days



Multinational Association for Supportive Care in Cancer                                       June 2004
                        Addressing “AC”* as a Separate Group
                                               Groups II - V
   Although not part of the official recommendations for acute
   emesis in MEC, the panel agreed that it should be
   recognized that women receiving a combination of
   anthracycline plus cyclophosphamide represents a
   situation with a particularly great risk of nausea and
   vomiting.

   Additionally, it appears that the risk of nausea and vomiting
   increases during multiple cycles.
* AC = Anthracycline + Cyclophosphamide, includes regimens such as: AC, EC, FAC,
       and FEC. A = doxorubicin, E = epirubicin, C = cyclophosphamide, F = 5-FU.



  Multinational Association for Supportive Care in Cancer              June 2004
                                  COMMITTEE V (1/2):

 Guideline for prevention of delayed nausea and vomiting in
 patients receiving moderately emetic chemotherapy:

 Patients who receive MEC known to be associated with a
 significant incidence of delayed nausea and vomiting should
 receive antiemetic prophylaxis for delayed emesis.

 MASCC level of confidence: high
 MASCC level of consensus: high

 ASCO level of evidence: I
 ASCO grade of recommendation: A



Multinational Association for Supportive Care in Cancer        June 2004
                                  COMMITTEE V (2/2):

 Guideline for prevention of delayed nausea and vomiting in patients
 receiving moderately emetic chemotherapy:
 Oral dexamethasone is the preferred treatment

 MASCC level of confidence: high
 MASCC level of consensus: high

 ASCO level of evidence: II
 ASCO grade of recommendation: A
 ------------------------------------------------------------------------------------------

 A 5-HT3 receptor antagonist may be used as an alternative.
 MASCC level of confidence: moderate
 MASCC level of consensus: moderate

 ASCO level of evidence: II
 ASCO grade of recommendation: B

Multinational Association for Supportive Care in Cancer                                       June 2004
                                 COMMITTEE VI (1/2):

 Guideline for prevention of acute nausea and vomiting in
 patients receiving low risk emetic agents*:

 A single agent (such as a low dose of a corticosteroid) is
 suggested for patients receiving agents of low emetic risk.

 MASCC: Level of confidence: No confidence possible.
 MASCC: Level of consensus: moderate

 ASCO level of evidence: III, IV
 ASCO grade of recommendation: D




Multinational Association for Supportive Care in Cancer        June 2004
                                 COMMITTEE VI (2/2):

 Guideline for prevention of acute nausea and vomiting in
 patients receiving minimal risk antineoplastic agents*:

 No antiemetic should be routinely administered before
 chemotherapy in patients without a history of nausea
 and vomiting.

 MASCC level of confidence: no confidence possible
 MASCC level of consensus: high

 ASCO level of evidence: V and expert consensus
 ASCO grade of recommendation: D

* While unusual at this emetic level, if a patient experiences emesis after guideline recommended therapy,
  it is advised that with subsequent treatment the regimen for the next higher emetic level should be given.



Multinational Association for Supportive Care in Cancer                                           June 2004
                                        COMMITTEE VII:

 Guideline for patients receiving multiple-day cisplatin:

 Patients receiving multiple-day cisplatin should receive a 5-HT3
 antagonist plus dexamethasone for acute nausea and vomiting
 and dexamethasone for delayed nausea and vomiting.

 MASCC level of confidence: high
 MASCC level of consensus: high

 ASCO level of evidence: II
 ASCO grade of recommendation: A

              No guideline was felt to be appropriate for rescue antiemesis or
  Note:       high-dose (i.e. transplant) chemotherapy

Multinational Association for Supportive Care in Cancer                          June 2004
                                      COMMITTEE VIII :




          Note:

          The best approach for anticipatory
          emesis is the best possible control of
          acute and delayed emesis




Multinational Association for Supportive Care in Cancer   June 2004
                                       COMMITTEE VIII:

 Guideline for managing anticipatory nausea and
 vomiting in patients receiving chemotherapy or RT

 Anticipatory nausea and vomiting should be managed by
 psychological techniques.

 MASCC level of confidence: high
 MASCC level of consensus: high
 -----------------------------------------------------------------------------------

 An alternative to or addition to psychological techniques is the
 use of benzodiazepines

 MASCC level of confidence: moderate
 MASCC level of consensus: high

Multinational Association for Supportive Care in Cancer                         June 2004
                                  COMMITTEE IX (1/5)
                  - Levels of Emetic Risk with Radiation Therapy (RT) -


        RISK LEVEL                                        AREA OF TREATMENT

  HIGH                                                          TBI

  MODERATE                                                Upper Abdomen

                                              Lower thorax region, Pelvis, Cranium
  LOW                                            (radiosurgery), Craniospinal



  MINIMAL                                  H & N, Extremities, Cranium, Breast



Multinational Association for Supportive Care in Cancer                          June 2004
                                 COMMITTEE IX (2/5):

 Guideline for preventing nausea and vomiting in
 patients receiving highly emetic RT: TBI

 Patients receiving highly emetic RT should receive
 a 5-HT3 antagonist plus dexamethasone.

 MASCC level of confidence: moderate
 MASCC level of consensus: high

 ASCO level of evidence: III
 ASCO grade of recommendation: C



Multinational Association for Supportive Care in Cancer   June 2004
                                 COMMITTEE IX (3/5):

 Guideline for preventing nausea and vomiting in patients
 receiving moderately emetic RT: Upper abdomen

 Patients receiving moderately emetic RT should receive
 a 5-HT3 antagonist.

 MASCC level of confidence: high
 MASCC level of consensus: high

 ASCO level of evidence: II
 ASCO grade of recommendation: A



Multinational Association for Supportive Care in Cancer   June 2004
                                     COMMITTEE IX (4/5):

 Guideline for preventing nausea and vomiting in patients receiving RT of
 low emetic risk: Lower thorax region, Pelvis, Cranium (radiosurgery), Craniospinal

 Patients receiving RT of low emetic risk should receive rescue with a 5-HT3 antagonist.

 MASCC level of confidence: low
 MASCC level of consensus: high

 ASCO level of evidence: IV
 ASCO grade of recommendation: D


 If patients receiving RT of low emetic risk experience emesis, they should then
 receive prophylaxis with a 5-HT3 antagonist.

 MASCC level of confidence: moderate
 MASCC level of consensus: high

 ASCO level of evidence: III
 ASCO grade of recommendation: B


Multinational Association for Supportive Care in Cancer                             June 2004
                                     COMMITTEE IX (5/5):


 Guideline for patients receiving RT of minimal emetic risk:
 H & N, Extremities, Cranium, Breast

 Patients receiving RT of minimal emetic risk should receive
 rescue with a dopamine antagonist or a 5HT3 antagonist.

 MASCC level of confidence: low
 MASCC level of consensus: high

 ASCO level of evidence: IV
 ASCO grade of recommendation: D




Multinational Association for Supportive Care in Cancer        June 2004
                           ANTIEMETIC RESEARCH (Comm X) (1/9)
                  - General Methodology: High and Moderate Risk -


 In Comparison Trials:

 • The emetic stimulus should be as similar as possible
        High Risk
          • Cisplatin vs Cisplatin in similar dose and schedule
          • Dacarbazine vs Dacarbazine in similar dose and schedule
        Moderate Risk
          • “AC” (EC, FAC) vs AC preferred over vs all moderate risk agents

 • Stratify (and analyze) according to known risk groups
           (especially: gender, age, alcohol history)
              Consider validating an algorithm of patient risk factors
                which could be used in research and practice
               The same would be of value in RT


Multinational Association for Supportive Care in Cancer                   June 2004
                  ANTIEMETIC RESEARCH (Comm X) (2/9)
             - General Methodology: Delayed Emesis (Com III & V) -


 • In addition to controlling the emetic stimulus,
           the antiemetic regimen for Acute Emesis should
           be the same for all patients

 • Guideline recommended regimens should
           be the basis for comparison studies

 • Trials should be designed to account for the patient’s
           response to the acute emesis regimen
             - Complete control vs < Complete control




Multinational Association for Supportive Care in Cancer              June 2004
                       ANTIEMETIC RESEARCH (Comm X) (3/9)
                         - Persistently Under-Addressed Areas -

 • Low risk settings – a lack of prospective trials(Com VI)
       - Not difficult to conduct
       - Optimal, economically sound regimens
       - Proven approaches when first-line is inadequate
 • Pediatrics (Com IX)
       - Studies continue to be few in number and low in quality
       - Surprising given the high percentage of patients on studies
 • Radiation Therapy (Com IX)
       - Specific trials continue to be necessary
       - Newer agents with potentially longer durations of action
         are particularly good study candidates
       - Validate risk models
 • Antiemetic Side Effects
       - Do agents affecting NK1 receptors influence blood counts?

Multinational Association for Supportive Care in Cancer                June 2004
                       ANTIEMETIC RESEARCH (Comm X) (4/9)
                    - Emerging Area of Focus: Controlling Nausea -

 • Methodology Issues:
       - Do patients have the same definition of “Nausea” that
         is implied in antiemetic trials? Is nausea confused with:
           - Anorexia?
           - Fatigue?
           - Pyrosis?
       - Is this a reason why trials show poorer nausea scores?
       - Nausea should be a primary endpoint in many clinical trials

 • Efficacy Issues:
       - This control lags behind the control of vomiting
       - Are other therapeutic interventions needed? Dex dose?
       - There is a high correlation between the control of
         vomiting and nausea…but is another mechanism involved?
       - Clearly a cause of great distress and a major need


Multinational Association for Supportive Care in Cancer                June 2004
                       ANTIEMETIC RESEARCH (Comm X) (5/9)
                        - Basic Science Studies and Correlations -


 • Investigation of new receptor families
         - Opioid Receptors
         - Cannabinoid Receptors
         - Other Receptor Candidates


 • Duration of action studies – with PET

 • Genetic / Molecular studies
         - Gene Arrays
         - Pharmacogenetic studies



Multinational Association for Supportive Care in Cancer              June 2004
                       ANTIEMETIC RESEARCH (Comm X) (6/9)
                         - Other Methodology Considerations -

 •    Prospective evaluation of emetic potential of: (Com I)
       - Newer Chemotherapy Agents: oxaliplatin, pemetrexed
       - “Novel Agents:” gefitinib, erlotinib, erbitux

 •    Long-term treatment studies (Com I)
       - Oral chemotherapy
       - RT

 •    Specific methodology in:
       - Multiple cycle studies
       - Rescue trials

 •    Prognostic Factor Investigation:
       - Are these the same when NK1 antagonists are used?
       - Gender / hormonal effects – including large data base reviews
       - Correlation of psychologic factors / expectations with outcomes

Multinational Association for Supportive Care in Cancer              June 2004
                       ANTIEMETIC RESEARCH (Comm X) (7/9)
                             - Economic Considerations -


 •    Economic factors should be addressed in appropriate
      studies:
       - Less costly regimens should be preferred when results are equal
       - Generic agents will likely have an increasing role
       - Reimbursement is a reality in regimen choice



 •    Economic studies:
       - Should be done by independent groups
       - The point of view (“Perspective”) should be identified
       - Beneficial to conduct prospectively, with randomized trials
       - More complete studies evaluate all costs


Multinational Association for Supportive Care in Cancer                June 2004
                       ANTIEMETIC RESEARCH (Comm X) (8/9)
                       - Utilization and Guideline Considerations -

 •    Guideline Use: Studies evaluating…
       - The impact on individuals with the use of guidelines
       - When and why guidelines are not followed
       - Successful strategies in increasing guideline use


 •    Perceived value of antiemetics (and emetic control)
       - Oncology Professionals
       - Patients
       - The Public

 •    Quality of Life Studies
       - Is there a need for further studies using a validated instrument?
       - The impact of emetic control on quality of life vis a vis other
          treatment factors


Multinational Association for Supportive Care in Cancer                June 2004
                                   ANTIEMETIC RESEARCH
                                - Committee X Conclusions (9/9) -

 •    Several areas of study in the immediate future are
       recommended based on:
       -    The emergence of newer agents
       -    Those areas with a low degree of guideline evidence
       -    Areas of poorer control and attention to nausea issues

 •    Methodology considerations will be even more important
       -    Better results with available regimens
       -    Long-standing problems that are difficult to study

 •    Molecular Techniques have great potential for this field

 •    It is imperative that cooperative groups and large “therapeutic” trials
      employ and investigate supportive care:
       -    Mandate established supportive care interventions
       -    Perform quality supportive care trials



Multinational Association for Supportive Care in Cancer                 June 2004

								
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