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The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Antiemesis address all aspects of management for chemotherapy-induced nausea and vomiting. These NCCN Guidelines Insights focus on recent updates to the NCCN Guidelines for Antiemesis, specifically those regarding carboplatin, granisetron, and olanzapine.

Before the introduction of the serotonin receptor antagonists (5-HT3 receptor antagonists) in the early 1990s, limited effective options were available to prevent and treat chemotherapy-induced nausea and vomiting (CINV). In 1985, the FDA approved 2 cannabinoid derivatives, dronabinol and nabilone, for the treatment of CINV not effectively treated by other agents. Today, the standard of care for prevention of CINV for highly and moderately emetogenic chemotherapy is a 5-HT3 receptor antagonist, dexamethasone, with or without aprepitant or fosaprepitant. With the approval of safer and more effective agents, cannabinoids are not recommended as first-line treatment for the prevention of CINV and are reserved for patients with breakthrough nausea and vomiting. Because of medical and legal concerns, the use of marijuana is not recommended for management of CINV and is not part of the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Antiemesis. Although patients may like to pursue this treatment option in states that have approved the use of marijuana for medical purposes, its use remains legally and therapeutically controversial.

2560Background: PQR is an oral pan-PI3K, mTORC1/mTORC2 inhibitor in clinical development. Methods: A Phase I trial of PQR to evaluate safety, PK and PD in pts with advanced solid tumors was performed, using the standard “3+3” design. Pts with ECOG PS of 0-1 were treated with escalating doses of PQR administered on a once daily continuous dosing schedule (qd). The dose limiting toxicity (DLT) period was the first 21 days of treatment. PK samples were obtained at predefined time points. Blood samples for the evaluation of glucose, insulin and c-peptide as PD markers were obtained at multiple time points. Results: 16 pts (11F:5M) were enrolled as of November 30 2015 and treated at 3 doses of PQR (80, 100 and 120 mg) qd. Median duration of therapy was 50 days (range 7 – 255). Adverse events (AEs) in ≥ 50% pts included fatigue, hyperglycemia, rash, nausea, vomiting, diarrhea and weight loss. Drug related grade 3 AEs seen in more than 1 pt were fatigue, hyperglycemia, rash and elevated transaminases. DLT’s were...

Chemotherapy-induced nausea and vomiting (emesis) can significantly affect a patient's quality of life, leading to poor adherence with further chemotherapy treatment. In addition, nausea and vomiting can result in other serious complications and deterioration of the patient's status. These guidelines explore the prevention, treatment, and management of various types of emesis experienced by cancer patients, such as breakthrough, radiation-induced, and anticipatory. For the most recent version of the guidelines, please visit NCCN.org