PRESCRIPTION PATTERN OF PROPHYLACTIC ANTIEMETICS IN BREAST CANCER PATIENTS: A RETROSPECTIVE OBSERVATIONAL STUDY IN A TERTIARY CARE HOSPITAL

Dwipen Khanikar; Indrani Bhagawati; Mitra Bhattacharyya; Lakhimi Borah; Kamal Ojha; Neelakshi Mahanta; Diptimayee Devi; Partha Prasanna D Singh; Sukainnya Buragohain

doi:10.22159/ajpcr.2023.v16i6.47336

Authors

Dwipen Khanikar Department of Pharmacology, Gauhati Medical College and Hospital, Guwahati, Assam, India.
Indrani Bhagawati Department of Pharmacology, Nalbari Medical College and Hospital, Nalbari, Assam, India.
Mitra Bhattacharyya Department of Pharmacology, Tezpur Medical College and Hospital, Tezpur, Assam, India.
Lakhimi Borah Department of Pharmacology, Nalbari Medical College and Hospital, Nalbari, Assam, India.
Kamal Ojha Department of Pharmacology, Gauhati Medical College and Hospital, Guwahati, Assam, India.
Neelakshi Mahanta Department of Medical Oncology, State Cancer Institute, Gauhati Medical College, Guwahati, Assam, India.
Diptimayee Devi Department of Pharmacology, Gauhati Medical College and Hospital, Guwahati, Assam, India.
Partha Prasanna D Singh Department of Pharmacology, Gauhati Medical College and Hospital, Guwahati, Assam, India.
Sukainnya Buragohain Department of Pharmacology, Jorhat Medical College and Hospital, Jorhat, Assam, India.

DOI:

https://doi.org/10.22159/ajpcr.2023.v16i6.47336

Keywords:

breast cancer, Antiemetic, Chemotherapy, Nausea, Vomiting

Abstract

Objective: The aim of the study was to study the prescription pattern of prophylactic antiemetics in breast cancer patients.

Methods: A retrospective observational study was carried out. Over a period of 3 months, all chemotherapy order sheets of breast cancer patients were collected and evaluated for prophylaxis of chemotherapy-induced nausea and vomiting (CINV). We compared each antiemetic drug used for CINV prophylaxis with international antiemetic guidelines, the National Comprehensive Cancer Network (NCCN).

Results: A total of 103 breast cancer patients were included in the study, for which 141 chemotherapy physician prescriptions included antiemetic drugs. Approximately 51.06% of anticancer agents had high emetic risk, 2.13% had moderate emetic risk, and 43.26% and 3.55% of anticancer agents had low and minimal emetic risk, respectively. Most frequently prescribed anticancer drug was paclitaxel 49 (34.75%). About 43.97% of the antiemetic regimen were found following NCCN guidelines.

Conclusion: The development of institutional policy for assessment and guidance of the chemotherapy-induced nausea and vomiting prophylaxis may improve the consistency between antiemetic prescribing and guidelines.

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References

Bloechl-Daum B, Deuson RR, Mavros P, Hansen M, Herrstedt J. Delayed nausea and vomiting continue to reduce patients’ quality of life after highly and moderately emetogenic chemotherapy despite antiemetic treatment. J Clin Oncol 2006;24:4472-8. doi: 10.1200/ JCO.2006.05.6382, PMID 16983116

Warr D. Standard treatment of chemotherapy-induced emesis. Support Care Cancer 1997;5:12-6. doi: 10.1007/BF01681956, PMID 9010984.

Ryckeghem FV, Belle SV. Management of chemotherapy-induced nausea and vomiting. Belg J Med Oncol 2009;3:212-7.

Dodd MJ, Onishi K, Dibble SL, Larson PJ. Differences in nausea, vomiting and retching between younger and older outpatients receiving cancer chemotherapy. Cancer Nurs 1996;19:155-61.

doi: 10.1097/00002820-199606000-00001, PMID 8674023

Goodman M. Risk factors and antiemetic management of chemotherapy-induced nausea and vomiting. Oncol Nurs Forum 1997;24 7 Suppl:20-32. PMID 9282378

Ouwerkerk J. Cancer therapy-induced emesis: The nurse’s perspective. Eur J Cancer Care (Engl) 1994;3:18-25. doi: 10.1111/j.1365-2354.1994. tb00005.x, PMID 7804562

Osoba D, Zee B, Pater J, Warr D, Latreille J, Kaizer L. Determinants of postchemotherapy nausea and vomiting in patients with cancer. Quality of Life and Symptom Control committees of the National Cancer Institute of Canada Clinical Trials Group. J Clin Oncol 1997;15:116-23. doi: 10.1200/JCO.1997.15.1.116, PMID 8996132

Molassiotis A, Yam BM, Yung H, Chan FY, Mok TS. Pretreatment factors predicting the development of postchemotherapy nausea and vomiting in Chinese breast cancer patients. Support Care Cancer 2002;10:139-45. doi: 10.1007/s00520-001-0321-4, PMID 11862503

Klein J, Tran W, Watkins E, Vesprini D, Wright FC, Hong NJ, et al. Locally advanced breast cancer treated with neoadjuvant chemotherapy and adjuvant radiotherapy: A retrospective cohort analysis. BMC Cancer 2019;19:306. doi: 10.1186/s12885-019-5499-2, PMID 30943923

Rao KV, Faso A. Chemotherapy-induced nausea and vomiting: Optimizing prevention and management. Am Health Drug Benefits 2012;5:232-40. PMID 24991322

Dipiro J, Burns M, Scwinghammer T, Wells B, Malone P, Kolesar J. Pharmacotherapy Principles and Practice. 4th ed. New York: McGraw- Hill Companies; 2016.

Aapro M. CINV: Still troubling patients after all these years. Support Care Cancer 2018;26:5-9. doi: 10.1007/s00520-018-4131-3

Roila F, Herrstedt J, Aapro M, Gra RJ, Einhorn LH, Ballatori E, et al. Guideline update for MASCC and ESMO in the prevention of chemotherapy- and radiotherapy-induced nausea and vomiting: Results of the Perugia consensus conference. Ann Oncol 2010;21 Suppl 5:v232-43. doi: 10.1093/annonc/mdq194, PMID 20555089

Basch E, Prestrud AA, Hesketh PJ, Kris MG, Feyer PC, Somerfield MR, et al. Antiemetics: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol 2011;29:4189-98. doi: 10.1200/ JCO.2010.34.4614, PMID 21947834

NCCN Clinical Practice Guidelines. Available from: http://www. nccn.org/professionals/physician_gls/pdfbreast.pdf [Last accessed on 2022 Aug 11].

Kawazoe H, Murakami A, Yamashita M, Nishiyama K, Kobayashi- Taguchi K, Komatsu S, et al. Patient-related risk factors for nausea and vomiting with standard antiemetics in patients with breast cancer receiving anthracycline-based chemotherapy: A retrospective observational study. Clin Ther 2018;40:2170-9. doi: 10.1016/j. clinthera.2018.10.004, PMID 30392814

Hesketh PJ, Kris MG, Basch E, Bohlke K, Barbour SY, Clark-Snow RA, et al. Antiemetics: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol 2017;35:3240-61. doi: 10.1200/ JCO.2017.74.4789

Jordan K, Warr DG, Hinke A, Sun L, Hesketh PJ. Defining the efficacy of neurokinin-1 receptor antagonists in controlling chemotherapy-induced nausea and vomiting in different emetogenic settings-A meta-analysis. Support Care Cancer 2016;24:1941-54. doi: 10.1007/s00520- 015-2990-4. PMID 26476625

Zaidan M, Soufi L, Hafeez M, Abdelwahid M, Rasul KI. Assessing prescribing patterns for the prevention of chemotherapy-induced nausea and vomiting in the national center for cancer care and research. Saudi Pharm J 2015;23:381-7. doi: 10.1016/j.jsps.2015.01.003, PMID 27134539

Pluzanski A, Kalinka E, Lacko A, Rubach M. Prevention of chemotherapy-induced nausea and vomiting-standards versus clinical practice. Oncol Clin Pract 2016;12:153-7. doi: 10.5603/OCP.201 6.0002

Tageja N, Groninger H. Chemotherapy-induced nausea and vomiting #285. J Palliat Med 2014;17:1400-2. doi: 10.1089/jpm.2014.9392, PMID 25401213

Roila F, Molassiotis A, Herrstedt J, Aapro M, Gralla RJ, Bruera E, et al. 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:v119-33. doi: 10.1093/annonc/mdw270, PMID 27664248

Multinational Association of Supportive Care in Cancer. MASCC/ ESMO Antiemetic Guidelines; 2019. Available from: https://www. mascc.org/antiemetic-guidelines [Last accessed on 2020 May 12].

National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology. Antiemesis. Version 2 [NCCN guidelines]; 2020. Available from: https://www.nccn.org/professionals/physiciangls/ PDF/antiemesis.pdf [Last accessed on 2020 May 12].

AKYNZEO. (Netupitant and Palonosetron) Capsules. Akynzeo (Fosnetupitant and Palonosetron) for Injection [Prescribing Information]. Dublin, Ireland: HelsinnBirex Pharmaceuticals Ltd.; 2020.

Cinvanti (aprepitant) Injectable Emulsion [Prescribing Information]. San Diego: HeronTherapeutics, Inc.; 2019.

Varubi (rolapitant) injectable emulsion. 2018. Available at https:// www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/varubi-rolapitant-injectable-emulsion

Jordan K. New formulation, new drug? The importance of assessing the safety of new supportive care formulations in oncology. Ann Oncol 2018;29:1494-6. doi: 10.1093/annonc/mdy187, PMID 29790903

European Medicines Agency. Summary of Opinion (Post Authorisation). Akynzeo (Fosnetupitant/Palonosetron). EMA/CHMP/670824/2019. Netherlands: European Medicines Agency. Available from: https:// www.ema.europa.eu/en/documents/smop-initial/chmp-summary-positive-opinionakynzeo_en.pdf [Last accessed on 2020 May 12].

Tesaro, Inc. Anaphylaxis, Anaphylactic Shock and other Serious Hypersensitivity Reactions Associated with Use of VARUBI (Rolapitant) Injectable Emulsion. United States: Tesaro, Inc.; 2018. Available from: https://www.fda.gov/media/110258/download [Last accessed on 2020 May 12].

ASD Healthcare. Varubi IV Distribution Suspension; 2018. Available from: https://www.asdhealthcare.com/asdhealthcare/media/asdlibrary/ pdfs/news/varubi-final-web-notice.pdf [Last accessed on 2020 May 12].

Schwartzberg L, Szabo S, Gilmore J, Haislip S, Jackson J, Jain G, et al. Likelihood of a subsequent chemotherapy-induced nausea and vomiting (CINV) event in patients receiving low, moderately or highly emetogenic chemotherapy (LEC/MEC/HEC). Curr Med Res Opin 2011;27:837-45. doi: 10.1185/03007995.2011.556603, PMID 21309647

Molassiotis A, Aapro M, Dicato M, Gascon P, Novoa SA, Isambert N, et al. Evaluation of risk factors predicting chemotherapy-related nausea and vomiting: Results from a European prospective observational study. J Pain Symptom Manage 2014;47:839-48.e4. doi: 10.1016/j. jpainsymman.2013.06.012, PMID 24075401

Navari RM, Aapro M. Antiemetic prophylaxis for chemotherapy-induced nausea andvomiting. N Engl J Med 2016;374:1356-67. doi: 10.1056/NEJMra1515442, PMID 27050207

Bosnjak SM, Gralla RJ, Schwartzberg L. Prevention of chemotherapy-induced nausea: The role of neurokinin-1 (NK1) receptor antagonists. Support Care Cancer 2017;25:1661-71.

Aapro M, Molassiotis A, Dicato M, Peláez I, Rodríguez-Lescure Á, Pastorelli D, et al. The effect of guideline-consistent antiemetic therapy on chemotherapy-induced nausea and vomiting (CINV): The Pan European Emesis Registry (PEER). Ann Oncol 2012;23:1986-92. doi: 10.1093/annonc/mds021, PMID 22396444

Gilmore JW, Peacock NW, Gu A, Szabo S, Rammage M, Sharpe J, et al. Antiemetic guideline consistency and incidence of chemotherapy-induced nausea and vomiting in US community oncology practice: INSPIRE study. J Oncol Pract 2014;10:68-74. doi: 10.1200/ JOP.2012.000816, PMID 24065402

Molassiotis A, Saunders MP, Valle J, Wilson G, Lorigan P, Wardley A, et al. A prospective observational study of chemotherapy-related nausea and vomiting in routine practice in a UK cancer centre. Support Care Cancer 2008;16:201-8. doi: 10.1007/s00520-007-0343-7, PMID 17926070

Burmeister H, Aebi S, Studer C, Fey MF, Gautschi O. Adherence to ESMO clinical recommendations for prophylaxis of chemotherapy-induced nausea and vomiting. Support Care Cancer 2012;20:141-7. doi: 10.1007/s00520-010-1079-3, PMID 21234609

Shah S, Singh A, Mundhava S. A study of drug utilization in patients of carcinoma breast receiving systemic chemotherapy in tertiary care hospitals. Asian J Pharm Clin Res 2021;14:116-9. doi: 10.22159/ ajpcr.2021.v14i4.40826

Roila F, Hesketh PJ, Herrstedt J, Antiemetic Subcommitte of the Multinational Association of Supportive Care in Cancer. Prevention of chemotherapy- and radiotherapy-induced emesis: Results of the 2004 Perugia International Antiemetic Consensus Conference. Ann Oncol 2006;17:20-8. doi: 10.1093/annonc/mdj078, PMID 16314401

Chan VT, Yeo W. Antiemetic therapy options for chemotherapy-induced nausea and vomiting in breast cancer patients. Breast Cancer (Dove Med Press) 2011;3:151-60. doi: 10.2147/BCTT.S12955, PMID 24367184

Lokkur PP, Mahanta N, Kalita NK, Deka H, Kutum N, Ray A. Prevalence of breakthrough chemotherapy-induced nausea vomiting in patients on highly emetogenic chemotherapy: A single-center observational study. Oncol J India 2021;5:92-6. doi: 10.4103/oji.oji_22_21

Satyasrinivas TR. Management of infusion reactions to taxane Based Chemotherapy: review Article. IOSR J Dent Med Sci 2016;15:22-6.

Okuyama A, Nakamura F, Higashi T. Prescription of prophylactic antiemetic drugs for patients receiving chemotherapy with minimal and low emetic risk. JAMA Oncol 2017;3:344-50. doi: 10.1001/ jamaoncol.2016.4096, PMID 27812688