價Check for updatesReceived:30 January 2023 Revised:3 April2023 Accepted:5 April2023D0k101002pbc30395PediatricBlood1DasphoCLINICAL PRACTICE GUIDELINECancerRcanaaCcaaWILEYTreatment of breakthrough and prevention of refractorychemotherapy-induced nausea and vomiting in pediatric cancerpatients:Clinical practice guideline updatePriya Patel12 Paula D.Robinson1 I Robert Phillips3 Christina Baggott4IKatie Devine5 I Paul Gibson1.6 Gregory M.T.Guilcher7.8 I Mark T.Holdsworth?Eloise Neumann10 I Andrea D.Orsey11,12 Daniela Spinelli13 I Jennifer Thackray14Marianne van de Wetering15 Sandra Cabral1 Lillian Sung16.17 L.Lee Dupuis2.17.18Pediatric Oncology Group of Ontario,Toronto.Ontario.Canada2Departmentof Pharmacy.The Hospital for Sick Children,Toronto,Ontario,Canada3Departmentof Haematology and Oncology.NHS Trust.Leeds Teaching Hospital,Leeds,UKCancer Clinical Trials Office,Stanford Cancer Institute,Palo Alto.California,USA5Rutgers Cancer Institute of New Jersey,New Brunswick,New Jersey,USADivisionof HaematologwOncology.McMaster Children's Hospital.Hamilton,Ontario.Canada7Sectionof PaediatricOnology and Blood and Marrow Transplant,Alberta Children's Hospital Calgary,Alberta,CanadaDepartments of Oncology and Fediatrics,University of Calgary Cumming School of Medicine,Calgary.Alberta,CanadaCollege of Pharmacy.University of New Mexico.Albuquerque,New Mexico.USAWomen'sand Children's Hospital Birmingham.UK11Divisionof Pediatric Hematologycology.Connecticut Children's Medical Center,Hartford,Connecticut USA12Departmentof Pediatrics,University of Connecticut Schoolof Medicine,Farmington Connecticut,USAPatientrepresentative4Departmentof Pharmacy.Memorial Sloan Kettering Cancer Center.New York,NewYork.USA15Princess Maxima Center for PediatricOncology.Utrecht.Netherlands16Departmentof Paediatrics,Division of Haematology/Oncology.The Hospitalfor Sick Children Toronto,Ontario,Canada47Child Health Evaluative Sciences,Research Institute.The Hospitalfor Sick Chilren.oronto.Ontario.CanadaLeslie Dan Faculty of Pharmacy.University of Toronto.Toronto.Ontario.CanadaCorrespondenceLLee Dupuis,Research Institute,The HospitalAbstractfor Sick Children,555 University Ave,Toronto,ON.M5G 1X8.Canada.This clinical practice guideline update provides recommendations for treating break-Email:lee.dupuis@sickkids.cathrough chemotherapy-induced nausea and vomiting(CINV)and preventing refractoryCINV in pediatric patients.Two systematic reviews of randomized controlled tri-als in adult and pediatric patients informed the recommendations.In patients withbreakthrough CINV,escalation of antiemetic agents to those recommended forchemotherapy of the next higher level of emetogenic risk is strongly recommended.A similar recommendation to escalate therapy is made to prevent refractory CINV inAbbreviations:(fos)aprepitant.intravenous fosaprepitant or oral aprepitant:5HT3RA serotonin-3receptor antagonist:CIN.chemotherapy-induced nausea:CINV.chemotherapy-induced nauseaand vomiting:CM.chemotherapy-induced v
