Chemotherapy-induced nausea and vomiting – standards in 2012

Abstract

In recent years, new drugs have increased efficacy in the prevention and control of chemotherapy-induced nausea and vomiting (CINV), however, vomiting, and especially nausea continue to be two of the most worrisome adverse effects of antineoplastic treatment. Antiemetic agents that have been identified to significantly improve the prophylaxis and treatment of CINV include the 5-HT3-receptor antagonists (RA), corticosteroids, neurokinin 1(NK1) receptor antagonists, dopamine receptor antagonists, benzodiazepines, neuroleptics and cannabinoids. However, there are still a significant number of patients experiencing CINV, either because of non-adherence to current treatment guidelines or due to the fact that antiemetic prophylaxis for new drugs, targeted therapies and prolonged oral therapy is not yet established appropriately. Due to the emergence of new findings and new antiemetic agents, the MASCC/ESMO and the ASCO updated their treatment guidelines for the prevention of CINV. The combination of anthracyclines and cyclophosphamide (AC) is classified as highly emetogenic and a triple therapy including a 5-HT3-RA, dexamethasone and an NK1-RA is recommended. While acute CINV can be sufficiently controlled with the combination of 5-HT3-RA plus dexamethasone, delayed CINV still remains a significant clinical problem. Palonosetron, a second-generation 5-HT3-RA, provides superior protection against both, nausea and vomiting, and demonstrated superior long-lasting CINV prevention in the delayed phase. Another recently approved agent is the NK1-RA fosaprepitant, which has shown equivalency in the prevention of both, acute and delayed CINV to aprepitant, and is used as a single day intravenous prophylaxis. This review provides an update of the revised clinical guidelines for antiemetic treatment and prophylaxis in cancer patients receiving chemotherapy.