Prophylaxe und Therapie Tumortherapie-induzierter Nausea und Emesis

Nausea and vomiting are still among the most feared side effects of antineoplastic therapy. Optimal antiemetic prophylaxis is therefore essential. In December last year, the European Society for Medical Oncology (ESMO) and the Multinational Association of Supportive Care in Cancer (MASCC) updated the guidelines on prevention of nausea and vomiting during chemotherapy and radiotherapy. As a basis for updating the recommendations, literature from the last guideline update in 2015 to January 2023 was systematically searched and evaluated. One aspect of the update is the classification of a total of 107 newly approved intravenous or oral tumor therapeutics with regard to their potential to cause vomiting or nausea. Among the antiemetics, olanzapine in particular has been upgraded. It is recommended that the atypical neuroleptic is added to the triple antiemesis with 5‑HT₃ (serotonin) receptor antagonist, dexamethasone, and neurokinin 1 (NK₁) receptor antagonist in highly emetogenic tumor therapy in the acute phase on day 1. Olanzapine is also recommended for the prevention of nausea and vomiting in the delayed phase of highly emetogenic tumor therapy and anthracycline–cyclophosphamide (AC)-based therapies for breast cancer. For the first time, the guideline now includes recommendations on integrative and nonpharmacological treatments, such as acupressure and acupuncture, progressive muscle relaxation, and the use of ginger, in addition to pharmacological measures. This article provides a detailed overview of the most important changes and innovations in the guideline update.