Efficacy of standard prophylaxis for nausea and vomiting in children receiving highly emetogenic chemo: real clinical practice

The chemotherapy-induced nausea and vomiting (CINV) are of the most difficult to tolerate, often distressing, complications from a patient's point of view. Despite the success of modern antiemetic therapy this problem is far from being solved and the real effectiveness of antiemetic prophylaxis in children in Russia has not been studied as yet. The purpose of the study was to evaluate the effectiveness of routine CINV prevention against the highly emetogenic chemo in real clinical practice. Materials and methods of the study: the study included 88 patients aged 5 to 18 years old who received treatment from October, 2020, till June, 2021. The median age of patients was 14 [12.5-16] years old; the boys/girls ratio was 53%/47%. During the observation period the studied patients received 456 cycles of highly emetogenic chemo - Me (Q1-Q3) 5 (3-7). All of the patients included in this single-center prospective cohort study have received a standard three-component prophylaxis regimen that consisted of aprepitant, dexamethasone and a 5HT-3 receptor blocker on days of cytostatic therapy. Nausea and vomiting were assessed using the MASCC Antiemesis Tool (MAT) questionnaire and Baxter Retching Faces (BARF) and Pediatric Nausea Assessment Tool (PeNAT) graphic scales. Results: thanks to the use of the standard antiemetic prophylaxis the total control of CINV was achieved in 312 (68%), 239 (52%) and 198 (43%) cycles in the acute, delayed and general periods, respectively. The factors that were statistically significantly associated with an increase in the incidence of CINV were as follows: multi-day chemo regimens (p=0.016), high doses of cisplatin or carboplatin in the treatment regimen (p<0.001) and anticancer therapy for a solid tumor (p=0.002). The presence of vomiting at the previous stage of cytostatic treatment also statistically significantly increased the incidence of CINV (p<0.001). Conclusion: against the background of standard antiemetic prophylaxis more than a half of all the children receiving highly emetogenic cytostatic therapy continue to suffer from CINV. This requires the development and implementation of a modern, more effective approaches to the CINV prevention. The risk factors for the development of CINV identified in the study could be of help in further studies in order to stratify patients into groups. The fact of a significant increase in the risk of CINV development in patients who experienced these complications during initial therapy indicates the need for the most effective prevention of CINV from the very first cycle of treatment.