Prevention and treatment of chemotherapy-induced nausea and vomiting: A review

Nausea and vomiting (emesis) are among the most distressing side effects of chemotherapy and are associated with significant clinical consequences and decreased health-related quality of life. The likelihood, severity, and duration of nausea and vomiting depend largely on the emetogenic potential of the chemotherapeutic agents. Four district types of chemotherapy-induced nausea and vomiting (CINV) have been described: acute, delayed, anticipatory, and breakthrough. The main therapeutic goal in the management of CINV is the prevention of both acute and delayed CINV beginning with the first chemotherapy cycle. Clinical practice guidelines provide specific recommendations for controlling the different types of CINV depending on the emetogenic potential of the chemotherapy regimen being used. Three classes of antiemetics are considered potent and well-tolerated options: 5-HT3 serotonin-receptor antagonists, corticosteroids, and neurokinin-l-receptor antagonists. A combination of these agents is recommended for patents receiving chemotherapy with high or moderate emetogenic potential. Phenothiazines, butyrophenones, cannabinoids, metoclopramide, and benzodiazepines are also sometimes used to prevent CINV caused by minimally emetogenic chemotherapy or to treat breakthrough CINV. This article reviews the currently available antiemetic agents and clinical practice guidelines for the management of CINV.