Chemotherapy-induced nausea and vomiting

Area of Science:

• Oncology
• Pharmacology
• Gastroenterology

Background:

• Chemotherapy-induced nausea and vomiting (CINV) is a common and debilitating side effect for cancer patients.
• CINV pathophysiology involves complex interactions between the gastrointestinal tract, nervous system, and various neurotransmitters, including serotonin, neurokinin-1, and dopamine receptors.

Purpose of the Study:

• To review the current understanding of CINV mechanisms and risk factors.
• To outline recommended antiemetic strategies for different chemotherapy regimens.
• To discuss pharmacological options for managing breakthrough and refractory CINV.

Main Methods:

• Review of existing literature on CINV.
• Analysis of neurotransmitter involvement in CINV.
• Categorization of antiemetic regimens based on chemotherapy emetogenicity and patient risk factors.

Main Results:

• Key neurotransmitter receptors involved in CINV are serotonin, neurokinin-1, and dopamine.
• Risk factors for CINV include patient demographics, prior CINV history, and chemotherapy properties.
• Specific antiemetic combinations are recommended for highly and moderately emetogenic chemotherapy, with options for breakthrough and refractory symptoms.

Conclusions:

• Optimal CINV management requires a multi-faceted approach considering chemotherapy type and patient-specific risk factors.
• Combination antiemetic therapy, including serotonin antagonists, dexamethasone, and aprepitant, is effective for high-risk CINV.
• Emerging evidence suggests potential roles for agents like olanzapine, casopitant, and gabapentin in CINV control.