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Chapter 99. Supportive Care in Oncology

Student Questions

Which of the following drugs is included in prophylactic antiemetic regimens to prevent delayed CINV?

A. Fosaprepitant

B. Ondansetron

C. Prochlorperazine

D. Dexamethasone

Answer: D

Option A: Incorrect. Although fosaprepitant has a long half-life, it is used to prevent CINV within the acute setting.

Option B: Incorrect. Ondansetron has a short half-life and is dosed at least twice or three times daily in the prevention of CINV in the acute setting. The 5HT3-antagonists as a class are not used to prevent CINV in the delayed setting.

Option C: Incorrect. Phenothiazines such as prochlorperazine have a short half-life and are used in the prevention of CINV in the acute setting as well as during the active phase of acute nausea or vomiting. They are not useful in the delayed setting.

Option D: Correct. Dexamethasone has been shown to prevent CINV in the delayed setting after chemotherapy administration. Dexamethasone is also not useful in the treatment of the active nausea or vomiting.

Which of the following is the most appropriate recommendation for the prevention of mucositis in a patient who is about to start treatment with a fluorouracil-based regimen for colon cancer?

A. Salt-water rinses

B. Palifermin

C. Sucralfate

D. Amifostine

Answer: A

Option A: Correct. The doses of fluorouracil that are used for solid tumors such as colon cancer are very low doses compared to the peripheral blood stem cell transplant setting and do not require any of the drug therapy options for prevention of mucositis.

Option B: Incorrect. Palifermin is only FDA-approved for prevention of mucositis associated with peripheral blood stem cell transplant.

Option C: Incorrect. Sucralfate is not recommended by practice guidelines for mucositis prevention, although sometimes used for symptomatic relief in clinical practice for treatment of mucositis.

Option D: Incorrect. Amifostine is only recommended as prevention of GI mucositis in the setting of radiation therapy for rectal cancers.

A patient is currently on day 12 of his admission post allogeneic peripheral blood stem cell transplant and has been febrile daily for the last 8 days. He is currently receiving cefepime. What else should be added to his regimen?

A. Vancomycin and caspofungin

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