What is your strategy for breakthrough chemotherapy induced N&V in patients receiving highly emetogenic chemotherapy and already received a NK-1 antagonist, 5-HT3 antagonist, dexamethasone, and olanzapine?

I find the MASCC anti-emetic guidelines to be very well written Davis et al., PMID 34398289.

Very few randomized clinical trials in cancer for antiemetics (with positive trials associated with metoclopramide (D2 receptor antagonist) and olanzapine).

So - most are based on trial and error + clinician p...

I also often take the age of the patient into account. Teenagers seem to do well with ativan +/- scopolamine patch for breakthrough CINV, while younger children (although usually have less nausea/vomiting in general) tend to respond better to reglan or benadryl/hydroxyzine.

Your answer also points t...

Acupuncture

Johnson et al., Alternative and Complementary Therapies 2015

I can send the full article if you are interested.