Consensus guidance for prevention and management of nausea and vomiting in patients treated with zolbetuximab + chemotherapy: a RAND/UCLA modified Delphi panel study

Background: This study aims to develop consensus-based guidelines to prevent and manage nausea and vomiting in patients treated with zolbetuximab plus chemotherapy. Materials and methods: An international Delphi panel included 15 experts who were involved in phase II or III clinical studies of zolbetuximab. A rating survey was developed, informed by literature and clinical experience, consisting of hypothetical scenarios of patients and interventions to prevent and manage nausea and vomiting during treatment with zolbetuximab plus chemotherapy. In April 2024, panelists rated the appropriateness of interventions on a scale of 1-9, discussed areas of disagreement in a virtual meeting, and repeated ratings following the meeting. The consensus was summarized based on responses to the second-round survey. Results: Areas of agreement were broader in the second-round survey than in the first-round survey, with panelists agreeing on 84.8% of ratings (second round) compared with 55.9% (first round). Agreement was reached on at least one management strategy for before and during the first zolbetuximab infusion and subsequent infusions. The Delphi panel endorses using the National Comprehensive Cancer Network® (NCCN®)-recommended regimens for high emetic risk prophylactically. During infusions, the Delphi panel suggested modifying the zolbetuximab infusion rate, interrupting zolbetuximab infusions temporarily for 30-60 min, administering antiemetic medications not used for prophylaxis, and/or providing intravenous hydration. Conclusions: These consensus-based guidelines can be utilized by clinicians to guide the prevention and management of nausea and vomiting in patients treated with zolbetuximab plus chemotherapy so that patients can continue receiving treatment and achieve benefits.