Richard Gralla's guest appearances

Richard Gralla

Blood & Cancer

David Fajgenbaum

Mason Plumlee

John Gribben

Kenneth Anderson

Arjun Balar

David Henry

Jack West

Glenn Pierce

Gustavo Fonseca

James Ferrara

Michael Weiner

Gary Lyman

Castleman Disease

Paula James

Brian Rini

OwlTail

In the first episode of Blood &amp; Cancer, David Henry, MD (http://bit.ly/2MFDfzm), welcomes Richard J. Gralla, MD (http://bit.ly/2ShsxEv), or the Albert Einstein College of Medicine in New York. The topic today centers around antiemetics and ways to use them. And later, Ilana Yurkiewicz, MD (https://stanford.io/2RXPixR), debuts her segment Clinical Correlations all about hematology care. Visit MDedge/hematology-oncology  Show Notes By Emily Bryer, DO  Highly emetic chemotherapy regimens include cisplatin, dacarbazine, anthracycline, and cyclophosphamide combinations  Treatment should include an NK1 receptor antagonist, dexamethasone, and a 5HT3 antagonist All 5HT3 antagonists should be given only once (no evidence that prn or delayed administration is helpful) Olanzapine is an effective antiemetic, although its precise role and dose are undergoing investigation An all-oral regimen for highly emetic could include Netupitant (NK1) and palonosetron (long-acting 5HT3) (NEPA) + Oral Dex + Olanzapine   Moderately emetic chemotherapy regimens include irinotecan and taxotere  Treatment should include 5HT3 antagonist and dexamethasone   Carboplatin causes more emesis than initially thought  Improvement with NK1 antagonist yields a 15% decreased risk of emesis Guidelines now recommending NK1 with carboplatin   Low emetic chemotherapy regimens include gemcitabine, pemetrexed as single agent  Single drug: one dose of corticosteroid or one dose of 5HT3 antagonist   Minimal emetic chemotherapy regimens include vincristine or bleomycin  No drugs are recommended for acute or delayed nausea/emesis   20 mg Dexamethasone IV (or 12 mg PO 12 mg) should be administered only on day 1 of chemotherapy. Dexamethasone can be spared after that unless cisplatin (would require 2 days of steroids) Marijuana and THC have some antiemetic properties, but are about one quarter as effective as 5HT3 antagonists Lorazepam may be used in anticipatory emesis started a few days prior to chemotherapy  References:  Ann Oncol. 2014 Jul;25(7):1333-9. JCSO 2015;13(4):128-30. JCSO 2016;4(1):11-20. Contact information: Contact us: podcasts@mdedge.com MDedge on Twitter: @mdedgehemonc Dr. Ilana Yurkiewicz on Twitter: @ilanayurkiewicz Dr. Yurkiewicz on MDedge: http://bit.ly/2DItTAb

In the first episode of Blood &amp; Cancer, David Henry, MD (<a href="http://bit.ly/2MFDfzm" rel="nofollow" target="_blank">http://bit.ly/2MFDfzm</a>), welcomes Richard J. Gralla, MD (<a href="http://bit.ly/2ShsxEv" rel="nofollow" target="_blank">http://bit.ly/2ShsxEv</a>), or the Albert Einstein College of Medicine in New York. The topic today centers around antiemetics and ways to use them. And later, Ilana Yurkiewicz, MD (<a href="https://stanford.io/2RXPixR" rel="nofollow" target="_blank">https://stanford.io/2RXPixR</a>), debuts her segment Clinical Correlations all about hematology care. Visit <a href="https://www.mdedge.com/hematology-oncology" rel="nofollow" target="_blank">MDedge/hematology-oncology</a> Show Notes By Emily Bryer, DO <ul> <li>Highly emetic chemotherapy regimens include cisplatin, dacarbazine, anthracycline, and cyclophosphamide combinations <ul> <li>Treatment should include an NK1 receptor antagonist, dexamethasone, and a 5HT3 antagonist</li> <li>All 5HT3 antagonists should be given only once (no evidence that prn or delayed administration is helpful)</li> <li>Olanzapine is an effective antiemetic, although its precise role and dose are undergoing investigation</li> <li>An all-oral regimen for highly emetic could include Netupitant (NK1) and palonosetron (long-acting 5HT3) (NEPA) + Oral Dex + Olanzapine</li> </ul> </li> <li>Moderately emetic chemotherapy regimens include irinotecan and taxotere <ul> <li>Treatment should include 5HT3 antagonist and dexamethasone</li> </ul> </li> <li>Carboplatin causes more emesis than initially thought <ul> <li>Improvement with NK1 antagonist yields a 15% decreased risk of emesis</li> <li>Guidelines now recommending NK1 with carboplatin</li> </ul> </li> <li>Low emetic chemotherapy regimens include gemcitabine, pemetrexed as single agent <ul> <li>Single drug: one dose of corticosteroid or one dose of 5HT3 antagonist</li> </ul> </li> <li>Minimal emetic chemotherapy regimens include vincristine or bleomycin <ul> <li>No drugs are recommended for acute or delayed nausea/emesis</li> </ul> </li> <li>20 mg Dexamethasone IV (or 12 mg PO 12 mg) should be administered only on day 1 of chemotherapy. Dexamethasone can be spared after that unless cisplatin (would require 2 days of steroids)</li> <li>Marijuana and THC have some antiemetic properties, but are about one quarter as effective as 5HT3 antagonists</li> <li>Lorazepam may be used in anticipatory emesis started a few days prior to chemotherapy</li> </ul> References:  <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4071753/" rel="nofollow" target="_blank">Ann Oncol. 2014 Jul;25(7):1333-9</a>. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4071753/" rel="nofollow" target="_blank">JCSO 2015;13(4):128-30.</a> <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4071753/" rel="nofollow" target="_blank">JCSO 2016;4(1):11-20.</a> Contact information: Contact us: <a href="mailto:podcasts@mdedge.com">podcasts@mdedge.com</a> MDedge on Twitter: <a href="https://twitter.com/MDedgeHemOnc" rel="nofollow" target="_blank">@mdedgehemonc</a> Dr. Ilana Yurkiewicz on Twitter: <a href="https://twitter.com/ilanayurkiewicz" rel="nofollow" target="_blank">@ilanayurkiewicz</a> Dr. Yurkiewicz on MDedge: <a href="http://bit.ly/2DItTAb" rel="nofollow" target="_blank">http://bit.ly/2DItTAb</a>

Antiemetics: Richard Gralla