In 2013 as part of its Choosing Wisely initiative,1 the American Society of Clinical Oncology (ASCO) recommended reserving relatively expensive antiemetics, eg, neurokinin1 receptor antagonists (NK1 RAs), for patients who were at high risk for emesis. ASCO classifies chemotherapy containing an anthracycline and cyclophosphamide (AC) as highly emetogenic, and thus an NK1 RA is recommended with AC treatments. Clemons and colleagues2 have tried to take this advice a step further with a risk-managed approach to antiemetics in women receiving AC in a setting where usual practice did not conform to ASCO guidelines.
Warr D, DeAngelis C, Chow E. Can Patient Risk Factors Outperform Antiemetic Guidelines? Choosing Wisely. JAMA Oncol. 2016;2(2):232–233. doi:10.1001/jamaoncol.2015.3757
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