Antiemetic therapy in Asia Pacific countries for patients receiving moderately and highly emetogenic chemotherapy—a descriptive analysis of practice patterns, antiemetic quality of care, and use of antiemetic guidelines
This paper reports prescribing patterns for prophylaxis of chemotherapy-induced nausea and vomiting (CINV) after highly or moderately emetogenic chemotherapy (HEC or MEC) for cancer in six Asia Pacific countries. In a prospective noninterventional study, 31 sites in Australia, China, India, Singapore, South Korea, and Taiwan recorded details of CINV prophylaxis for the acute phase (first 24 h) and delayed phase (days 2–5) after single-day HEC or MEC for adult patients. Additional information on CINV prophylactic medications was collected from 6-day patient diaries. Primary antiemetic therapies were defined as corticosteroids, the 5-hydroxytryptamine-3 receptor antagonists (5HT3-RAs), and neurokinin-1 receptor antagonists (NK1-RAs). Evaluable patients in cycle 1 numbered 648 (318 [49 %] HEC and 330 [51 %] MEC) of mean (SD) age of 56 (12) years, including 58 % women. For the acute phase after HEC, overall (and country range), 96 % (91–100 %) of patients received a 5HT3-RA, 87 % (70–100 %) a corticosteroid, and 43 % (0–91 %) an NK1-RA. CINV prophylaxis for the HEC delayed phase was more variable: including 22 % (7–65 %) 5HT3-RA, 52 % (12–93 %) corticosteroid, and 46 % (0–88 %) NK1-RA. For the MEC acute phase, 97 % (87–100 %) of patients received 5HT3-RA and 86 % (73–97 %) a corticosteroid. For the MEC delayed phase, 201 patients (61 %) received a primary antiemetic, including 5HT3-RA (41 %), corticosteroid (37 %), and/or NK1-RA (4 %). The 5HT3-RAs were prescribed consistently in all countries, while prescribing of other antiemetic therapies was variable, and corticosteroids were under-prescribed for CINV prophylaxis, particularly in the delayed phase.