2025 Southeastern Residency Conference

Title: 
Incidence of nausea and vomiting with modified antiemetic regimens for patients receiving carboplatin AUC ≥ 4


Authors: Ramsey Shane, Amanda Cass


Objective: 
The purpose of this study is to determine the incidence of CINV with different antiemetic regimens and alterations in antiemetic regimens in patients receiving a modified antiemetic regimen with carboplatin AUC ≥ 4. 


Background: 
Chemotherapy-induced nausea and vomiting (CINV) is a major side effect of cancer treatment that affects patient quality of life. The National Comprehensive Cancer Network (NCCN) provides CINV recommendations for patients based on the emetic risk of the chemotherapy agents in their regimen, previous use of antiemetic agents, and patient risk factors. In the updated 2017 NCCN CINV guidelines, carboplatin emetic potential was updated from all carboplatin doses being moderately emetogenic to carboplatin AUC < 4 classified as moderately emetogenice and AUC ≥ 4 as highly emeticemetogenic. This recommendation adds neurokinin-1 receptor antagonists (NK-1 RA) to the standard regimen of a 5-HT3 receptor antagonists and dexamethasone with or without olanzapine for antiemetic prophylaxis in patients receiving carboplatin with AUC ≥ 4 mg/mL. There is debate amongst clinicians if the highly emetic classification is clinically necessary empirically citing additional adverse effects of antiemetic agents and financial burden for the healthcare system as reasons. The current practice at Vanderbilt University Medical Center (VUMC) includes a variety of antiemetic options for treatment plans including carboplatin AUC ≥4, and antiemetic regimens are decided by disease state groups based on their experience. Thus, not all regimens using carboplatin AUC ≥ 4 are treated as a highly emetic chemotherapy regimen.


Methods:
A retrospective, single-center cohort analysis was conducted including patients who received chemotherapy regimens containing carboplatin AUC ≥ 4 between January 2019 through July 2024 at the Vanderbilt Ingram Cancer Center (VICC). The treatment plans included in this study came from patients receiving treatment for either lung, gynecologic, or gastrointestinal cancers. Additionally, patients had to complete at least 2 cycles of therapy with carboplatin AUC ≥ 4. Patients were excluded if their treatment plan contained other cytotoxic chemotherapy agents except for paclitaxel. Data was collected through chart review in electronic medical record. The primary objective was to determine the incidence of CINV with different antiemetic regimens and if there was a change in the antiemetic regimen during treatment with carboplatin and up to three weeks after the carboplatin dose.  


Results: 
A total of 243 patients were screened for inclusion across the three disease states. There were 50 patients included from gynecology and lung cancers, and there were 41 patients included from the gastrointestinal cancers. Data analysis is still ongoing. 


Conclusion:
In Progress