The low down on keeping it down.

What’s the single biggest advancement in cancer care in the last half-century? Some say it’s antiemetics. Here are updated ASCO guidelines on cancer-related antiemetic use based on data published over the past 5 years. Updates since 2017 include that adding immune checkpoint inhibitors should not change established recs for steroid prophylaxis. High emetic risk chemos (e.g. cisplatin or anthracycline combos) merit prophylaxis with a 4-drug cocktail of an NK1 receptor antagonist (e.g. aprepitant), a serotonin receptor antagonist (e.g. Zofran), dexamethasone, and olanzapine. Lesser risk agents can get away with lesser prophylaxis in a stepwise manner. Same with high risk radiation (e.g. TBI), during which patients should receive prophylactic Zofran and dex, as compared to prophylactic Zofran alone for CSI or upper abdominal radiation. When something is needed in addition to the go-to agents above, Ativan—and to a lesser extent synthetic cannabis or, with radiation, a dopamine antagonist (e.g. Reglan)—remain great adjunctive antiemetics. TBL: In 2020, there are fortunately several data-informed antiemetics in our armamentarium. | Hesketh, J Clin Oncol 2020