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Among the side effects of anticancer treatment, chemotherapy-induced nausea and vomiting (CINV) is one of the most feared given its high prevalence, affecting up to 40% of patients. It can impair patient's quality of life and provoke low adherence to cancer treatment or chemotherapy dose reductions that can comprise treatment efficacy. Suffering CINV depends on factors related to the intrinsic emetogenicity of antineoplastic drugs and on patient characteristics. CINV can appear at different times regarding the administration of antitumor treatment and the variability of risk according to the different antitumor regimens has, as a consequence, the need for a different and adapted antiemetic treatment prophylaxis to achieve the desired objective of complete protection of the patient in the acute phase, in the late phase and in the global phase of emesis. As a basis for the recommendations, the level of emetogenicity of anticancer treatment is considered and they are classified as high, moderate, low and minimal emetogenicity and these recommendations are based on the use of antiemetic drugs with a high therapeutic index: anti 5-HT, anti-NK and steroids. Despite having highly effective treatments, clinical reality shows that they are not applied enough, so evidence-based recommendations are needed to show the best options and help in decision-making. To cover all the antiemetic prophylaxis options, we have also included recommendations for oral treatments, multiday regimens and radiation-induced emesis prevention.

[EN] Finding angiogenic prognostic markers in advanced non-small-cell lung cancer is still an unmet medical need. We explored a set of genetic variants in the VEGF-pathway as potential biomarkers to predict clinical outcomes of patients with non-small-cell lung cancer treated with chemotherapy plus bevacizumab. We prospectively analyzed the relationship between VEGF-pathway components with both pathological and prognostic variables in response to chemotherapy plus bevacizumab in 168 patients with non-squamous non-small-cell lung cancer. Circulating levels of VEGF and VEGFR2 and expression of specific endothelial surface markers and single-nucleotide polymorphisms in VEGF-pathway genes were analyzed. The primary clinical endpoint was progression-free survival. Secondary endpoints included overall survival and objective tumor response. VEGFR-1 rs9582036 variants AA/AC were associated with increased progression-free survival (p = 0.012 and p = 0.035, respectively), and with improved overall survival (p = 0.019) with respect to CC allele. Patients with VEGF-A rs3025039 harboring allele TT had also reduced mortality risk (p = 0.049) compared with the CC allele. The VEGF-A rs833061 variant was found to be related with response to treatment, with 61.1% of patients harboring the CC allele achieving partial treatment response. High pre-treatment circulating levels of VEGF-A were associated with shorter progression-free survival (p = 0.036). In conclusion, in this prospective study, genetic variants in VEGFR-1 and VEGF-A and plasma levels of VEGF-A were associated with clinical benefit, progression-free survival, or overall survival in a cohort of advanced non-squamous non-small-cell lung cancer patients receiving chemotherapy plus antiangiogenic therapy., The authors thank Drs. Blanca Piedrafita and Vanessa Marfil at Medical Statistics Consulting for medial writing services. RR also wish to acknowledge the support by the Asociacion Espanola Contra el Cancer (AECC).

Plain Language Summary Low levels of sodium in the blood occur in almost half of patients with cancer who are hospitalized. In some patients, this may be fatal. A care pathway was developed by the Sociedad Espanola de Oncologia Medica in 2014 to support doctors in providing the best care for these patients. Clinical records for 70 patients with cancer at four Spanish hospitals were reviewed to determine whether treatment was given according to the care pathway. Less than one-third of patients were found to have been treated according to the pathway. Patients receiving chemotherapy were more likely to have been treated according to the pathway; however, doctors believed that more patients were treated in line with the pathway. In general, health outcomes were similar for those patients treated according to and not treated according to the pathway. The difference between doctors' belief that the pathway was followed when it might not have been needs to be examined further, say the authors. They suggest several reasons for the difference. The doctor providing feedback on whether the patient was treated according to the pathway may not have been the only doctor involved in a patient's care and may not have been aware of all the treatment choices made. Lack of clarity within the pathway may have led doctors to believe that it was being followed more often than it was. Importantly, a doctor's judgment may need to override pre-defined pathways in some situations to achieve the best outcome for the patient. Introduction The ALGA study explored adherence of Spanish treatment centers to the Sociedad Espanola de Oncologia Medica (SEOM) treatment algorithm for oncology patients with hyponatremia that requires treatment as the main cause of hospitalization, and evaluated the impact of adherence to this algorithm on patient outcomes. Methods This retrospective study recruited patients aged at least 18 years with cancer, treated for at least one episode of hyponatremia secondary to the syndrome of inappropriate antidiuretic hormone secretion (SIADH). The primary outcome was the proportion of patients whose treatment adhered to the SEOM algorithm, evaluated using a pre-defined decision tree. Secondary outcomes included length of hospitalization, and time to serum sodium level improvement. Perceived center adherence to the SEOM algorithm was also assessed. Results Seventy patients from four treatment centers were included. Twenty (28.6%; 95% confidence interval [CI] 18.0, 39.2) patients on hyponatremia treatment adhered to the SEOM algorithm, with a perceived adherence of 51.0-75.0%. Algorithm adherence in candidates for chemotherapy was 36.4% (n = 8) versus 25.0% (n = 12) for non-candidates for chemotherapy. Median time to serum sodium level improvement in patients managed adherently was 80.5 h (95% CI 38.3, 331.4) versus 134.6 h (33.2, 444.9) in patients managed non-adherently. Median time to hospital discharge was 16.5 days (95% CI 8.0, 27.0) in patients managed adherently versus 9.5 days (7.0, 22.0) in patients managed non-adherently. Conclusion In Spanish centers, the SEOM algorithm was adhered to in less than one-third of patients, in contrast to higher levels of perceived adherence. This requires further investigation; however, algorithm use could require further clarification, especially in non-candidates for chemotherapy.

Background Sorafenib is a potent targeted-therapy that blockades angiogenesis and has demonstrated activity against some sarcoma subtypes. Preclinical studies suggested that treatment with sorafenib plus cytotoxic agents could result in additive efficacy. Methods Patients with advanced soft tissue sarcoma, with or without anthracycline pretreatment were included. Patients received oral sorafenib 400 mg twice daily starting on Day +2, ifosfamide 2.0 g/m2 iv infusion lasting 4 h on days 1. 2 and 3 with concurrent mesna 400 mg/m(2) every three weeks until disease progression or unacceptable toxicity or up to a maximum of 6 cycles of ifosfamide (sorafenib could be continued until progressive disease or unacceptable toxicity). Primary objective was progression-free rate (PFR) at 3 and 6 months; secondary objectives were overall response rate (ORR), Progression-free survival (PFS), Overall survival (OS) and safety. This article reports the phase II part of a phase I/II clinical trial. Results Thirty-five patients were enrolled. PFR at 3 and 6 months was 66% (95% CI 48-81) and 37% (95% CI 22-55). Six patients (17%) achieved partial response and 17 (49%) stable disease. Median PFS was 4.8 months (CI 95% 1.94-6.36) and overall survival 16.2 months (95% CI 8.75-NA). Conclusion Treatment with sorafenib plus ifosfamide achieved a significant clinical benefit with an acceptable safety profile in patients with advanced soft tissue sarcoma resistant to anthracyclines, which warrants a more detailed study in randomized clinical trials.

Chemotherapy-induced nausea and vomiting is one of the most worrisome adverse effects of chemotherapy for cancer patients. It can cause severe discomfort and affect the quality of life. In recent years, the incorporation of new drugs has increased the efficacy of antiemetic treatments in the control of emesis associated with chemotherapy. This guideline, in which we give some treatment recommendations with level of evidence and grade of recommendation, provides an update of the previously published guideline of the Spanish Society of Medical Oncology and represents our continued commitment to improving supportive care in cancer patients.