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

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.

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Fosaprepitant (MK-0517): a neurokinin-1 receptor antagonist for the prevention of chemotherapy-induced nausea and vomiting

Expert Opinion on Investigational Drugs ◽

10.1517/13543784.16.12.1977 ◽

2007 ◽

Vol 16 (12) ◽

pp. 1977-1985 ◽

Cited By ~ 28

Author(s):

Rudolph M Navari

Keyword(s):

Receptor Antagonist ◽

Nausea And Vomiting ◽

Neurokinin 1 Receptor ◽

Neurokinin 1

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Corticosteroids, the oldest agent in the prevention of chemotherapy-induced nausea and vomiting: What about the guidelines?

Journal of Translational Internal Medicine ◽

10.1515/jtim-2016-0010 ◽

2016 ◽

Vol 4 (1) ◽

pp. 46-51 ◽

Cited By ~ 3

Author(s):

Florence Van Ryckeghem

Keyword(s):

Cost Effective ◽

Daily Practice ◽

Patient Characteristics ◽

Optimal Level ◽

Chemotherapeutic Agents ◽

Nausea And Vomiting ◽

Antiemetic Therapy ◽

Receptor Antagonists ◽

Treatment Research ◽

Antiemetic Agents

AbstractChemotherapy-induced nausea and vomiting (CINV) remains one of the most disturbing side effects of cancer treatment. Research in antiemetic therapy has progressed gradually since the early eighties, and the development of antiemetic agents continues. This review focuses on the current management of CINV based on the most recent guidelines, and adherence to the latter is examined more carefully. Setrons (5HT3 receptor antagonists), corticosteroids, and NK-1 receptor antagonists are the cornerstones of antiemetic therapy. Corticosteroids are one of the oldest agents in the prevention of CINV. They are highly effective, increase the effect of other antiemetic agents, and are cost-effective. The latest developed 5HT3 receptor antagonist palonosetron led to an update of the guidelines of CINV. Other types include benzodiazepines, cannabinoids, and olanzapine. Various factors contribute to the overall risk of developing CINV, such as patient characteristics, emetogenic potency of the chemotherapeutic agents, and correct prevention of CINV. Current guidelines determine which is the right preventive regimen for each cancer patient at risk for experiencing CINV. Adherence to these guidelines and implementation in daily practice seem to be below the optimal level. In Belgium, authorities use the guidelines as a base for reimbursement and this has increased the level of implementation.

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Evolving role of neurokinin 1-receptor antagonists for chemotherapy-induced nausea and vomiting

OncoTargets and Therapy ◽

10.2147/ott.s158570 ◽

2018 ◽

Vol Volume 11 ◽

pp. 6459-6478 ◽

Cited By ~ 9

Author(s):

Rudolph M. Navari ◽

Lee S. Schwartzberg

Keyword(s):

Nausea And Vomiting ◽

Receptor Antagonists ◽

Neurokinin 1 Receptor ◽

Neurokinin 1

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AN EXTENSIVE REVIEW ON CHEMOTHERAPY INDUCED NAUSEA AND VOMITING

Journal of Drug Delivery and Therapeutics ◽

10.22270/jddt.v8i5-s.1958 ◽

2018 ◽

Vol 8 (5-s) ◽

pp. 79-81

Author(s):

P Bhulakshmi ◽

GV Nagaraju ◽

K Srilaya

Keyword(s):

Receptor Antagonist ◽

Standard Of Care ◽

Emetogenic Chemotherapy ◽

Nausea And Vomiting ◽

Fixed Dose ◽

Nk1 Receptor Antagonist ◽

The Us ◽

Dose Combination ◽

Delayed Cinv

Chemotherapy induced nausea and vomiting is the among most feared and debilitating adverse events experienced by the cancer patients. Left unaddressed, CINV symptoms not only decrease quality of life, but may also affect patients’ willingness to continue chemotherapy treatment. However, adherence to guideline recommendations continues to be suboptimal therapy, and many patients still suffer unnecessarily from CINV. In addition, breakthrough/refractory CINV continues to present particular challenges. The development of effective CINV treatments with diverse mechanisms of action has expanded the options available for preventing symptoms. The US Food and Drug Administration have recently approved several new therapies for the management of CINV. NEPA is a fixed-dose combination of Netupitant (300 mg) plus Palonosetron (0.5 mg). In combination with Dexamethasone, NEPA has demonstrated superior efficacy to Palonosetron alone in patients receiving highly or moderately emetogenic chemotherapy. Rolapitant is a nextgeneration neurokinin-1receptor antagonist. Both palonosetron and rolapitant have proven particularly effective in controlling delayed CINV. Regimens that combine a serotonin 5-hydroxytryptamine–3 receptor antagonist, an NK1 receptor antagonist, and a corticosteroid now represent the standard of care for managing both acute and delayed CINV in patients receiving highly emetogenic chemotherapy. Keywords: CINV, Seratonin, Dopamine, Neurokinin, Antiemetics.

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