TY - JOUR
T1 - Evaluation of new antiemetic agents and definition of antineoplastic agent emetogenicity - State of the art
AU - Grunberg, Steven M.
AU - Warr, David
AU - Gralla, Richard J.
AU - Rapoport, Bernardo L.
AU - Hesketh, Paul J.
AU - Jordan, Karin
AU - Espersen, Birgitte T.
N1 - Funding Information:
Acknowledgement The 2009 MASCC/European Society of Medical Oncology (ESMO) Antiemetic Guideline Update Consensus Meeting was funded by unrestricted grants from Eisai Inc, GlaxoSmithKline, Helsinn Healthcare SA, Merck & Co. Inc., and Prostrakan Group. These sources had no role in the design, conduct, or results of the conference nor in the preparation of data or this manuscript. Additionally, funding was received from the ESMO and the MASCC. MASCC organized the meeting. Individual members of either or both these organizations participated in the meeting and preparation of the manuscript.
PY - 2011/3
Y1 - 2011/3
N2 - Antiemetic drug development can follow the same logical path as antineoplastic drug development from appropriate preclinical models through Phase I, Phase II, and Phase III testing. However, due to the marked success of antiemetic therapy over the last 25 years, placebo antiemetic treatment against highly or moderately emetogenic chemotherapy is not acceptable. Promising antiemetic agents therefore rapidly reach Phase III testing, where they are substituted into or added to effective and accepted regimens. One challenge of antiemetic drug development is determining whether substitution is indeed acceptable or whether prior regimens must be maintained intact as a basis for further antiemetic drug development. An additional challenge is the classification of emetogenic level of new antineoplastic agents. Accurate reporting of emetogenicity of such antineoplastic agents in the absence of preventive antiemetic treatment may not be available. However, at the 2009 Multinational Association of Supportive Care in Cancer (MASCC)/European Society of Medical Oncology (ESMO) Consensus Conference, an expert panel used best available data to establish rankings of emetogenicity. Oral chemotherapeutic agents are ranked separately from intravenous agents, recognizing intrinsic differences in emetogenicity as well as differing schedules of administration. Since oral chemotherapeutic agents are often administered in extended regimens, the distinction between acute and delayed emesis is less clear, and cumulative emesis must be considered. As control of vomiting has improved, attention has shifted to control of nausea, a related but distinct and equally important problem. Additional efforts will be necessary to understand mechanisms of nausea and to identify optimal remedies.
AB - Antiemetic drug development can follow the same logical path as antineoplastic drug development from appropriate preclinical models through Phase I, Phase II, and Phase III testing. However, due to the marked success of antiemetic therapy over the last 25 years, placebo antiemetic treatment against highly or moderately emetogenic chemotherapy is not acceptable. Promising antiemetic agents therefore rapidly reach Phase III testing, where they are substituted into or added to effective and accepted regimens. One challenge of antiemetic drug development is determining whether substitution is indeed acceptable or whether prior regimens must be maintained intact as a basis for further antiemetic drug development. An additional challenge is the classification of emetogenic level of new antineoplastic agents. Accurate reporting of emetogenicity of such antineoplastic agents in the absence of preventive antiemetic treatment may not be available. However, at the 2009 Multinational Association of Supportive Care in Cancer (MASCC)/European Society of Medical Oncology (ESMO) Consensus Conference, an expert panel used best available data to establish rankings of emetogenicity. Oral chemotherapeutic agents are ranked separately from intravenous agents, recognizing intrinsic differences in emetogenicity as well as differing schedules of administration. Since oral chemotherapeutic agents are often administered in extended regimens, the distinction between acute and delayed emesis is less clear, and cumulative emesis must be considered. As control of vomiting has improved, attention has shifted to control of nausea, a related but distinct and equally important problem. Additional efforts will be necessary to understand mechanisms of nausea and to identify optimal remedies.
KW - Classification
KW - Emetogenicity
KW - Nausea
KW - Vomiting
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UR - http://www.scopus.com/inward/citedby.url?scp=79953318777&partnerID=8YFLogxK
U2 - 10.1007/s00520-010-1003-x
DO - 10.1007/s00520-010-1003-x
M3 - Article
C2 - 20972805
AN - SCOPUS:79953318777
SN - 0941-4355
VL - 19
SP - S43-S47
JO - Supportive Care in Cancer
JF - Supportive Care in Cancer
IS - SUPPL. 1
ER -