IntroductionThe treatment of relapsed ovarian cancer involves rechallenge with platinum based chemotherapy. One regimen commonly in use at the Christie for platinum resistant disease is the dose dense cisplatin and etoposide regimen familiarily known as “Rotterdam”1. Local guidelines classify this regimen as having a high emetogenic potential and recommend the use of a 5HT3 antagonist together with dexamethasone and metoclopramide. Anecdotally it was felt that there was a high level of antiemetic treatment failure with an adverse effect on patient outcomes and well being. The purpose of this audit was to assess the effectiveness of current antiemetic prescribing practice and make recommendations that would improve patient outcomes 

MethodsData was extracted from the medical records of 100 patients receiving Rotterdam chemotherapy during a two year period. Data was collected per cycle and included grade of nausea and vomiting experienced using CTCAE 4.0 grading criteria, changes to antiemetic therapy and any treatment delays.

Results

Optimising antiemetic control in relapsed ovarian cancerAbigail Williams1 Geoff Saunders2

1 University of Manchester 2 The Christie NHS Foundation Trust

The mean age of patients included in the study was 60 years. Two thirds of patients reported some degree of nausea and vomiting, with ten reporting grade 3 nausea and nine grade 3 vomiting.Eleven patients were admitted to hospital with nausea or vomiting given as a contributory cause. 17 patients were initiated on non standard antiemetics for a variety of reasons including allergies, disease state and previous experience. A further 47 patients required at least one change to their antiemetic requirements with 17 requiring two or more. The most frequent changes were: addition of aprepitant, switching to palanosetron and changing to cyclizineThree patients experienced dose delays and four stopped treatment altogether due to nausea and vomiting.

Additional antiemetics prescribed to treat nausea/ vomiting 

Discussion and conclusionThis audit has demonstrated that the current antiemetic regimen in use is not optimal and could be improved. Although half of all the patients required a change to their antiemetic therapy and despite a wide range of therapeutic strategies employed; the fact that only 17 required at least one more change suggests that 80% of patients could be given optimal care from the start by adding aprepitant to the recommended standard antiemetics bringing it in line with international guidelines2.

References:1.M van de Burgh, R de Wit, W van Putten, A Logmans et al. Weekly cisplatin and daily etoposide is highly effective in platinum pretreated ovarian cancer. The British Journal of Cancer. 2002; 86: 19-252.MASCC/ESMO Antiemetic Guideline 2013 http://www.mascc.org/assets/documents/mascc_guidelines_english_2013.pdf accessed 25.09.13 last updated 26.02.13

Antiemetic No. of patients

Aprepitant 34

Cyclizine 29

Palanosetron 21

Levomepromazine 16

Incr. Dexamethasone 14

Incr. Ondansetron 12

Incr. Metoclopramide 3

Domperidone 2

Proclorperazine 2

Granisetron 1

Diazepam 105

10

152025

30

3540

45

50

Day 8 Day 15 Day 29 Day 36 Day 43

Day nausea/vomiting was first reported

Freq

uen

cy

Nausea

Vomiting

0

5

10

15

20

25

30

35

Grade 1 Grade 2 Grade 3 Grade 4

Highest grade of nausea/vomiting experienced by patients

Freq

uen

cy

Nausea

Vomiting