by Agent G

Created on: July 21, 2009   Last Updated: July 22, 2009

Chemotherapy induced nausea and vomiting (CINV) is a side effect that can be mitigated or avoided by the appropriate prophylactic medications. Nausea and vomiting associated with cancer chemotherapy are experienced by 70%-80% of patients receiving chemotherapy and 10% to 44% experience anticipatory nausea and/or vomiting. (Morran 1978, Morrow 1991) This can result in significant morbidity. CINV impacts self-care and functional ability, and cause a decline in performance status. In addition, CINV can result in metabolic imbalances, anorexia, esophageal tears, and wound dehiscence. As a result, patients who may benefit from potentially effective therapy may display poor adherence or withdraw from further chemotherapy. (Ingle 1984, Ricahrdson 1988)

National Comprehensive Cancer Network (NCCN) Guidelines recommend that the choice of antiemetic therapy should be based on the emetic risk associated with the chemotherapy to be administered, the dosage, schedule, and route of administration, and the patient's prior experience with antiemetics. Consideration must also be given to patient-associated factors, including age, sex, prior chemotherapy, and history of alcohol consumption. The main goal is to prevent CINV. Patients need to be protected throughout the entire period of risk, as different chemotherapeutic agents have different emetogenic potentials postadministration. (NCCN 2009, Jordan 2007, Grote 2006)

The emetogenic potential of the specific chemotherapeutic agent being administered is directly related to the frequency of CINV. Although several classifications have been developed to define the emetogenic potential of chemotherapeutic agents, none has been universally accepted. (Moreno 2002) Hesketh et al. developed a classification system and an algorithm to define the emetogenic potential of combination regimens. (Grunberg 2005) This system was updated by Grunberg et al. and forms the basis of current consensus guidelines. Although implementation of guidelines provides a better control of CINV with higher complete response rate, data indicate that some practitioners still do not treat their patients according to the recommendations. Poor control of CINV and delayed emesis may lead to impaired quality of life and decreased compliance with treatment. (Jordan 2007)

Several classes of antiemetic drugs are available to prevent or treat CINV. Older agents include phenothiazines, antihistamines, and corticosteroids. Serotonin (5-HT3) receptor antagonists became

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