1. Introduction The treatment of relapsed ovarian cancer involves rechallenge with platinum based chemotherapy. One regimen commonly in use at the Christie for platinum resistant disease is the dose dense cisplatin and etoposide regimen familiarily known as “Rotterdam ”1. Local guidelines classify this regimen as having a high emetogenic potential and recommend the use of a 5HT 3 antagonist together with dexamethasone and metoclopramide. Anecdotally it was felt that there was a high level of antiemetic treatment failure with an adverse effect on patient outcomes and well being. The purpose of this audit was to assess the effectiveness of current antiemetic prescribing practice and make recommendations that would improve patient outcomes Methods Data was extracted from the medical records of 100 patients receiving Rotterdam chemotherapy during a two year period. Data was collected per cycle and included grade of nausea and vomiting experienced using CTCAE 4.0 grading criteria, changes to antiemetic therapy and any treatment delays. Results Optimising antiemetic control in relapsed ovarian cancer Abigail Williams 1 Geoff Saunders 2 1 University of Manchester 2 The Christie NHS Foundation Trust The mean age of patients included in the study was 60 years. Two thirds of patients reported some degree of nausea and vomiting, with ten reporting grade 3 nausea and nine grade 3 vomiting. Eleven patients were admitted to hospital with nausea or vomiting given as a contributory cause. 17 patients were initiated on non standard antiemetics for a variety of reasons including allergies, disease state and previous experience. A further 47 patients required at least one change to their antiemetic requirements with 17 requiring two or more. The most frequent changes were: addition of aprepitant, switching to palanosetron and changing to cyclizine Three patients experienced dose delays and four stopped treatment altogether due to nausea and vomiting. Additional antiemetics prescribed to treat nausea/ vomiting Discussion and conclusion This audit has demonstrated that the current antiemetic regimen in use is not optimal and could be improved. Although half of all the patients required a change to their antiemetic therapy and despite a wide range of therapeutic strategies employed; the fact that only 17 required at least one more change suggests that 80% of patients could be given optimal care from the start by adding aprepitant to the recommended standard antiemetics bringing it in line with international guidelines 2. References: 1. M van de Burgh, R de Wit, W van Putten, A Logmans et al. Weekly cisplatin and daily etoposide is highly effective in platinum pretreated ovarian cancer. The British Journal of Cancer. 2002; 86: 19-25 2. MASCC/ESMO Antiemetic Guideline 2013 http://www.mascc.org/assets/documents/mascc_guidelines_engl ish_2013.pdf accessed 25.09.13 last updated 26.02.13 AntiemeticNo. of patients Aprepitant34 Cyclizine29 Palanosetron21 Levomepromazine16 Incr. Dexamethasone14 Incr. Ondansetron12 Incr. Metoclopramide3 Domperidone2 Proclorperazine2 Granisetron1 Diazepam1