Optimal use of antiemetics in the outpatient setting

Nausea and vomiting are the toxicities of chemotherapy most feared by the cancer patient. However, increased understanding of the mechanisms of nausea and vomiting has led to greatly improved control of this toxicity. Greater flexibility of dose, schedule, and route of administration of effective antiemetic agents has played a significant role in making outpatient administration and management of chemotherapy possible. Advances in this area are based on identification of relevant neurotransmitters and neurotransmitter receptors, and development of effective antagonists for these sites. Antidopaminergic (D2) agents have given way to antiserotonergic (5-HT3) agents, which, when used with corticosteroids, are highly effective in the prevention of acute emesis. Recent work suggests that neurokinin (NK-1) antagonists will have an equal impact on the management of delayed emesis. Investigation of additional potentially important neurotransmitter receptors, such as the opioid and cannabinoid receptors, may result in further improvements in antiemetic control and quality of life in coming years.