Revisiones en Cáncer H0154
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Emesis y quimioterapia. Más allá de los setrones y los antagonistas del receptor NK1

Publicado: 2023-03-29

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La dexametasona es un fármaco eficaz en la profilaxis de náuseas y vómitos inducidos por quimioterapia. Debe formar parte de los regímenes antieméticos para quimioterapia del alto y moderado potencial emético; en monoterapia puede ser utilizada en la profilaxis de quimioterapia de bajo potencial emético. En regímenes de quimioterapia de moderado potencial emético es posible reducir la dosis total de dexametasona sin perder eficacia antiemética. Olanzapina se ha demostrado como un fármaco eficaz en la profilaxis de regímenes de quimioterapia de alto potencial emético y debe ser de primera elección en el tratamiento de la emesis imprevista a pesar de profilaxis en el caso de que no fuese parte de la combinación antiemética administrada en profilaxis. Los agentes antidopaminérgicos pueden ser fármacos de uso en la emesis imprevista a pesar de profilaxis. Investigaciones futuras deberán definir el papel de amisulprida. Las benzodiacepinas pueden ser de utilidad en el control de la emesis anticipatoria.

Palabras Clave: Emesis inducida por quimioterapia. Dexametasona. Corticoides. Metoclopramida. Antagonistas del receptor de dopamina. Olanzapina. Benzodiacepinas.

Lyons E, Line C, Lee JJ. Developing drugs for prevention of chemotherapy-induced nausea and vomiting: draft guidance from FDA. Clin Cancer Res 2021;27:6072-4.
Dranitsaris G, Molassiotis A, Clemons M, Roeland E, Schwartzberg L, Dielenseger P, et al. The development of a prediction tool to identify cancer patients at high risk for chemotherapy-induced nausea and vomiting. Ann Oncol 2017;28:1260-7.
Navari RM, Ruddy KJ, LeBlanc TW, Nipp R, Clark-Snow R, Schwartzberg L, et al. Avoidable Acute Care Use Associated with Nausea and Vomiting Among Patients Receiving Highly Emetogenic Chemotherapy or Oxaliplatin. Oncologist 2021;26:325-31.
Navari RM, Aapro M. Antiemetic prophylaxis for chemotherapy-induced nausea and vomiting. N Engl J Med 2016;374:1356-67.
Aapro M. CINV: still troubling patients after all these years. Support Care Cancer 2018;26(Suppl1):s5-s9.
Herrstedt J. The latest consensus on antiemetics. Curr Opin Oncol 2018;30:233-9.
Czock D, Keller F, Rasche FM, Häussler U. Pharmacokinetics and pharmacodynamics of systemically administered glucocorticoids. Clin Pharmacokinet 2005;44:61-98.
Rhen T, Cidlowski JA. Antiinflammatory action of glucocorticoids - New mechanisms for old drugs. N Engl J Med 2005;353:1711-23.
Morrow GR, Andrews PL, Hickok JT, Roscoe JA, Matteson S. Fatigue associated with cancer and its treatment. Support Care Cancer 2002;10:389-98.
Darmani NA, Ray AP. Evidence for a re-evaluation of the neurochemical and anatomical bases of chemotherapy-induced vomiting. Chem Rev 2009;109:3158-99.
Hesketh PJ, Kris MG, Basch E, Bohlke K, Barbour SY, Clark-Snow RA. Antiemetics: ASCO Guideline Update. J Clin Oncol 2020;38:2782-97.
Antiemesis. Version 1.2022. Disponible en: Acceso Marzo 2022.
Roila F, Molassiotis A, Herrstedt J, Aapro M, Gralla RJ, Bruera E, et al.; participants of the MASCC/ESMO Consensus Conference Copenhagen 2015. 2016 MASCC and ESMO guideline update for the prevention of chemotherapy- and radiotherapy-induced nausea and vomiting and of nausea and vomiting in advanced cancer patients. Ann Oncol 2016;27(Suppl. 5):v119-v133.
Italian Group for Antiemetic Research. Double-blind, dose-finding study of four intravenous doses of dexamethasone in the prevention of cisplatin-induced acute emesis. J Clin Oncol 1998;16(9):2937-42.
Italian Group for Antiemetic Research. Randomized, double- blind, dose-finding study of dexamethasone in preventing acute emesis induced by anthracyclines, carboplatin, or cyclophosphamide. J Clin Oncol 2004;22(4):725-9.
Ioannidis JP, Hesketh PJ, Lau J. Contribution of dexamethasone to control of chemotherapy-induced nausea and vomiting: a meta-analysis of randomized evidence. J Clin Oncol 2000;18:3409-22.
Okada Y, Oba K, Furukawa N, Kosaka Y, Okita K, Yuki S, et al. One-Day Versus Three-Day Dexamethasone in Combination with Palonosetron for the Prevention of Chemotherapy-Induced Nausea and Vomiting: A Systematic Review and Individual Patient Data-Based Meta-Analysis. Oncologist 2019; 24:1593-600.
Celio L, Cortinovis D, Cogoni AA, Cavanna L, Martelli O, Carnio S, et al. Dexamethasone-sparing regimens with oral netupitant and palonosetron for the prevention of emesis caused by high-dose cisplatin: a randomized noninferiority study. Oncologist 2021;26:e1854-e1861.
Van Der Vorst MJDL, Toffoli EC, Beusink M, Van Linde ME, Van Voorthuizen T, Brouwer S, et al. Metoclopramide, Dexamethasone, or Palonosetron for Prevention of Delayed Chemotherapy- Induced Nausea and Vomiting after Moderately Emetogenic Chemotherapy (MEDEA): A randomized, Phase III, noninferiority trial. Oncologist 2021;26:e173-e181.
Jeong Y, Han HS, Lee HD, Yang J, Jeong J, Choi MK, et al. A Pilot Study Evaluating Steroid-Induced Diabetes after Antiemetic Dexamethasone Therapy in Chemotherapy-Treated Cancer Patients. Cancer Res Treat 2016;48(4):1429-37.
Suh KJ, Yoon S, Kim JW, Yoon SH, Kim JW, Kim SH, et al. A single-arm feasibility study of gradual dose de-escalation of antiemetic dexamethasone for older patients receiving chemotherapy. J Geriatr Oncol 2021;12(6):922-9.
Brahmer JR, Lacchetti C, Schneider BJ, Atkins MB, Brassil KJ, Caterino JM, et al. National Comprehensive Cancer Network. Management of Immune-Related Adverse Events in Patients Treated with Immune Checkpoint Inhibitor Therapy: American Society of Clinical Oncology Clinical Practice Guideline. J Clin Oncol 2018;36(17):1714-68.
Maher VE, Fernandes LL, Weinstock C, Tang S, Agarwal S, Brave M, et al. Analysis of the Association Between Adverse Events and Outcome in Patients Receiving a Programmed Death Protein 1 or Programmed Death Ligand 1 Antibody. J Clin Oncol 2019;37(30):2730-7.
Janowitz T, Kleeman S, Vonderheide RH. Reconsidering Dexamethasone for Antiemesis when Combining Chemotherapy and Immunotherapy. Oncologist 2021;26(4):269-73.
Connell CM, Raby S, Beh I, Flint TR, Williams EH, Fearon DT, et al. Cancer immunotherapy trial registrations increase exponentially but chronic immunosuppressive glucocorticoid therapy may compromise outcomes. Ann Oncol 2017;1678-9.
Vardy J, Chiew KS, Galica J, Pond GR, Tannock IF. Side effects associated with the use of dexamethasone for prophylaxis of delayed emesis after moderately emetogenic chemotherapy. Br J Cancer 2006;94(7):1011-5.
Han HS, Park JC, Park SY, Lee KT, Bae SB, Kim HJ, et al. A Prospective Multicenter Study Evaluating Secondary Adrenal Suppression After Antiemetic Dexamethasone Therapy in Cancer Patients Receiving Chemotherapy: A Korean South West Oncology Group Study. Oncologist 2015;20(12):1432-9.
Jeong Y, Han HS, Lee HD, Yang J, Jeong J, Choi MK, et al. A Pilot Study Evaluating Steroid-Induced Diabetes after Antiemetic Dexamethasone Therapy in Chemotherapy-Treated Cancer Patients. Cancer Res Treat 2016;48(4):1429-37.
Belkacemia L, Darmani NA. Dopamine receptor in emesis: molecular mechanisms and potential therapeutic function. Pharmacol Res 2020;161:105124.
Pleuvry BJ. Physiology and pharmacology of nausea and vomiting. Anaesth Intensive Care 2012;13:598-612.
Smith HS, Cox LR, Smith BR. C. Dopamine receptor antagonists Ann Paliat Med 2012;1:137-42.
Longstreth GF, Hesketh PJ. Characteristics of antiemetics drugs. Available from: This topic last updated: Jul 19, 2021.
Hesketh PJ. Chemotherapy-induced nausea and vomiting. NEJM 2008;358:2482-94.
Tan HS, Dewinter G, Habib AS. The next generation of antiemetics for the management of postoperative nausea and vomiting. Best Pract Res Clin Anaesthesiol 2020;34:759-69.
Navari R. Olanzapine for the prevention and treatment of chronic nausea and chemotherapy-induced nausea and vomiting. Eur J Pharmacol 2014;722:180-6.
Mikuzami N, Yamauchi M, Koike K, Watanabe A, Ichihara K, Masumori N, et al. Olanzapine for the prevention of chemotherapy- induced nausea and vomiting in patients receiving highly or moderately emetogenic chemotherapy: A randomized, double- blind, placebo-controlled study. J Pain Sympton Manage 2014;47:542-50.
Navari RM, Gray SE, Kerr AC. Olanzapine versus Aprepitant for the prevention of chemotherapy-induced nausea and vomiting: A randomized phase III trial. J Support Oncol 2011;9:188-95.
Navari RM, Quin R, Ruddy Kj, Liu H, Powell SF, Bajaj M, et al. Olanzapine for the prevention of chemotherapy induced nausea and vomiting. N Engl J Med 2016;375:134-42.
Navari RM, Nagy CK, Gray SE. The use of olanzapine versus metoclopramide for the treatment of breakthrough chemotherapy- induced nausea and vomiting in patients receiving highly emetogenic chemotherapy. Support Care Cancer 2013;21: 1655-63.
Hashimoto H, Abe M, Tokuyama O, Mizutani H, Uchitomi Y, Yamaguchi T, et al. Olanzapine 5 mg plus standard antiemetic therapy for the prevention of chemotherapy-induced nausea and vomiting (J-FORCE): a multicentre, randomized, double-blind, placebo-controlled, phase 3 trial. Lancet Oncol 2020;21:242-9.
Wang DY, Chen Y, Zhang Y, Shen YQ. The Balance Between the Effectiveness and Safety for Chemotherapy-Induced Nausea and Vomiting of Different Doses of Olanzapine (10 mg Versus 5 mg): A Systematic Review and Meta-Analysis. Front Oncol 2021;11:705866.
Chow R, Herrstedt H, Aapro M, Chiu L, Lam H, Prsic E, et al. Olanzapine for the prophylaxis and rescue of chemotherapy-induced nausea and vomiting: a systematic review, meta-analysis, cumulative meta-analysis and fragility assessment of the literature. Support Care Cancer 2021;29:3439-59.
Bashashati M, McCallum RW. Neurochemical mechanisms and pharmacologic strategies in managing nausea and vomiting related to cyclic vomiting syndrome and other gastrointestinal disorders. Eur J Pharmacol 2014;722:79-94.
Sharkey KA, Darmani NA, Parker LA. Regulation of nausea and vomiting by cannabinoids and the endocannabinoid system. Eur J Pharmacol 2014;722:134-46.
Whiting PF, Wolff RF, Deshpande S, Di Nisio M, Duffy S, Hernandez AV, et al. Cannabinoids for medical use: A systematic review and meta-analysis. JAMA 2015;31:2456.

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