Clinical practice guidelines on antiemetics in oncology

Area of Science:

• Oncology
• Pharmacology

Background:

• Chemotherapy-induced nausea and vomiting (CINV) significantly impacts patient tolerability.
• Existing antiemetic drugs, such as 5-hydroxytryptamine-3 receptor antagonists, have limitations in controlling CINV.
• Timing (acute, delayed) and emetogenicity of chemotherapy are critical factors in CINV management.

Purpose of the Study:

• To review the role of neurokinin-1 receptor antagonists, specifically aprepitant, in improving antiemetic therapy.
• To outline updated guidelines for antiemetic prophylaxis and treatment based on chemotherapy emetogenicity and CINV timing.

Main Methods:

• Review of current literature on antiemetic drugs and CINV management protocols.
• Analysis of the efficacy of aprepitant as an adjunct to standard antiemetic regimens.
• Development of evidence-based recommendations for different chemotherapy emetogenicity levels.

Main Results:

• Aprepitant, when added to standard regimens (5-hydroxytryptamine-3 receptor antagonists and steroids), significantly increases complete response rates for CINV.
• For highly emetogenic chemotherapy, a combination of 5-HT3 antagonist, dexamethasone, and aprepitant is recommended for the acute phase.
• For moderately emetogenic chemotherapy, aprepitant is recommended for both acute and delayed phases, often combined with dexamethasone.

Conclusions:

• Aprepitant is a valuable addition to antiemetic regimens, enhancing control of chemotherapy-induced nausea and vomiting.
• Tailored antiemetic strategies incorporating aprepitant are crucial for improving patient outcomes and chemotherapy tolerability.
• Guidelines should differentiate prophylaxis and treatment based on chemotherapy's emetogenic potential and symptom onset.