Delayed emesis: incidence, pattern, prognostic factors and optimal treatment

Area of Science:

• Oncology
• Pharmacology

Background:

• Delayed emesis, defined as nausea or vomiting >24 hours post-chemotherapy, significantly impacts patient quality of life.
• Acute emesis severity is a key predictor of subsequent delayed emesis.
• Chemotherapy-induced nausea and vomiting (CINV) remains a challenging side effect in cancer treatment.

Purpose of the Study:

• To define optimal antiemetic prophylaxis strategies for preventing delayed emesis.
• To identify effective antiemetic regimens for patients undergoing highly or moderately emetogenic chemotherapy.

Main Methods:

• Review of current definitions and prognostic factors for delayed emesis.
• Analysis of antiemetic efficacy for different chemotherapy regimens.
• Recommendations for prophylactic antiemetic use based on emetogenic potential.

Main Results:

• High-dose cisplatin (>= 50 mg/m(2)) necessitates antiemetic prophylaxis due to high incidence and severity of delayed emesis.
• Combination therapy with dexamethasone plus metoclopramide or a 5-HT3 antagonist is the most effective regimen for cisplatin-treated patients.
• Oral dexamethasone prophylaxis is recommended for patients receiving moderately emetogenic chemotherapy (e.g., cyclophosphamide, carboplatin, doxorubicin, epirubicin).

Conclusions:

• Prophylactic antiemetic administration is crucial for managing delayed emesis in patients receiving high-dose cisplatin.
• Tailored antiemetic strategies, including combination therapies, improve control of chemotherapy-induced nausea and vomiting.
• Dexamethasone monotherapy is recommended for preventing delayed emesis in moderately emetogenic chemotherapy settings.