In a clinical practice guideline published in Pediatric Blood and Cancer, researchers offered updated recommendations regarding chemotherapy emetogenicity classification in pediatric oncology patients and provided data they deemed crucial for the appropriate selection of antiemetic prophylaxis.

The researchers conducted a systematic review of articles reporting data on chemotherapy-induced nausea in pediatric patients. The review included 87 publications that the researchers used to develop an emetogenicity classification for 49 single‐agent and 13 combined‐agent regimens. Because few pediatric studies had evaluated nausea severity using a validated pediatric tool, the researchers focused exclusively on chemotherapy‐induced vomiting (CIV) prevention.

The clinical practice guideline panel chose to use only evidence in pediatric patients instead of in adults when developing its recommendations, since CIV risk factors may be different in adult and pediatric patients. However, this had significant limitations as many of the studies included did not evaluate CIV as a primary or secondary outcome.

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Furthermore, pediatric patients often received antiemetic prophylaxis in combination with emetogenic chemotherapy agents. As a result, the researchers developed a framework and algorithm for classifying the emetogenicity of chemotherapy agents in pediatric patients receiving CIV prophylaxis. In cases where evidence on a chemotherapy agent’s emetogenicity conflicted, the panel assigned the agent to the higher classification.

The authors noted that for many chemotherapy agents and doses, there was no direct evidence to inform the risk for CIV in pediatric patients. Therefore, several agents that form the standard of care for some common pediatric cancers do not appear in this classification.

Reference

1.     Paw Cho Sing E, Robinson PD, Flank J, et al. Classification of the acute emetogenicity of chemotherapy in pediatric patients: a clinical practice guideline [published online February 7, 2019]. Pediatr Blood Cancer. doi: 10.1002/pbc.27646