A Review of the Prevention of Nausea and Vomiting Induced by Chemotherapy

Abstract

Chemotherapy-induced nausea and vomiting (CINV) is associated with a significant deterioration in quality of life. The emetogenicity of the chemotherapeutic agents, repeated chemotherapy cycles and patient risk factors significantly influence CINV. The use of a combination of 5-hydroxytryptamine-3 (5-HT3) receptor antagonists, dexamethasone and a neurokinin-1 (NK-1) receptor antagonist has significantly improved the control of acute and delayed emesis in single-day chemotherapy. Palonosetron, a second-generation 5-HT3 receptor antagonist with a unique mechanism of action, appears to be the most effective agent in its class. Aprepitant, the only agent clinically available in the drug class of NK-1 receptor antagonists, has been used effectively as an additive agent to the 5-HT3 receptor antagonists and dexamethasone. Despite the control of emesis, nausea has not been well controlled by current agents. Olanzapine, a US Food and Drug Administration-approved antipsychotic, has emerged in recent trials as effective for the prevention of chemotherapy-induced emesis and nausea and for the treatment of breakthrough emesis and nausea. Additional studies are necessary for the control of nausea and for the control of CINV in the clinical settings of multi-day chemotherapy and bone marrow transplantation.