54 PART TWO | CHEMOTHERAPY-INDUCED NAUSEA AND VOMITING Methods Search strategy We conducted a systematic search in PubMed and conference proceedings of ASCO, ESMO and MASCC in August 2014. For PubMed the following syntax was applied: “chemotherapy-induced nausea and vomiting [tiab]” OR “CINV [tiab]” OR “emesis [tiab]” OR “delayed nausea [tiab]” OR “moderately emetogenic [tiab]” OR “MEC [tiab]”, with limits: clinical trial, full text, English, humans, adult, and date from January 1th 2009 to July 31th 2014. An electronic search was undertaken of conference proceedings of ASCO, ESMO, and MASCC from January 1th 2009 to July 31th 2014. Selection criteria Potentially relevant studies retrieved by the PubMed and conference proceedings searches were independently reviewed for eligibility by two investigators (M.V.D.V. and E.C.W.N.). Any disagreement between the reviewers was resolved by re-examination and subsequent discussion to reach a consensus. Unpublished or retrospective studies were not considered eligible. Levels of evidence were not used to assess the value of each publication selected for inclusion. The following criteria for inclusion were applied: a) The study aimed to prospectively evaluate the efficacy of two or more antiemetic strategies in the prevention of delayed CINV after the administration of moderately emetogenic chemotherapy not containing anthracyclines and cyclophosphamide (non-AC MEC); b) At least one of the following endpoints was used in the study: 1) complete response; 2) complete control; 3) no nausea; 4) no vomiting; or 5) no use of rescue medication. Studies on patients receiving chemotherapy with mixed emetogenicity (HEC and/or AC and/or non-AC MEC) were included only if subgroup analysis (pre-planned or ad hoc) of the nonAC MEC subgroup was performed. When data on AC and non-AC MEC were combined, it was arbitrarily decided to include studies in which the percentage of patients receiving AC was less than 50% in the subgroup analysis. Both RCTs in which the antiemetic therapies only differed beyond day 1, and RCTs in which there was a difference starting at day 1 were included. Data extraction Extracted items were: study design, number of patients included, number of patients receiving non-AC MEC, tumor types, emetogenic level of assessed chemotherapeutic agents, primary efficacy endpoints, intervention, and reported results. Because of the heterogeneity in study designs, risk of bias, and variety in patient populations, conducting a meta-analysis was not possible. Results Number of studies meeting selection criteria Using the PubMed syntax and aforementioned limits, 247 potentially relevant studies were identified. Figure 1 depicts the subsequent stepwise selection of 9 eligible studies.
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