The American Society of Clinical Oncology (ASCO) has issued an update to its guideline on the use of antiemetics in oncology (issued in 2006).  A literature search was conducted to identify any new evidence of relevance and the following new recommendations have been made (taken from the abstract):

• Combined anthracycline and cyclophosphamide regimens were reclassified as highly emetic. Patients who receive this combination or any highly emetic agents should receive a 5-HT3 receptor antagonist, dexamethasone, and a neurokinin 1 (NK1) receptor antagonist.

• A large trial validated the equivalency of fosaprepitant, a single-day intravenous formulation, with aprepitant; either therapy is appropriate.

• Preferential use of palonosetron is recommended for moderate emetic risk regimens, combined with dexamethasone.

• For low-risk agents, patients can be offered dexamethasone before the first dose of chemotherapy.

• Patients undergoing high emetic risk radiation therapy should receive a 5-HT3 receptor antagonist before each fraction and for 24 hours after treatment and may receive a 5-day course of dexamethasone during fractions 1 to 5.

• The Update Committee noted the importance of continued symptom monitoring throughout therapy. Clinicians underestimate the incidence of nausea, which is not as well controlled as emesis.