Cancer therapy, vomiting, and antiemetics

Area of Science:

• Oncology
• Pharmacology
• Gastroenterology

Background:

• Radiotherapy and chemotherapy are common cancer treatments that frequently induce nausea and vomiting.
• These side effects are believed to result from a complex interplay of peripheral (gastrointestinal) and central (chemoreceptor trigger zone) mechanisms, rather than direct neural stimulation.
• Factors influencing severity include radiation specifics (dose, field size, fractionation), chemotherapy agents, and individual patient characteristics.

Purpose of the Study:

• To review the mechanisms underlying radiotherapy- and chemotherapy-induced nausea and vomiting.
• To discuss the factors influencing the frequency and severity of these side effects.
• To explore current and emerging antiemetic strategies for cancer patients.

Main Methods:

• Literature review of mechanisms and management of treatment-induced nausea and vomiting.
• Analysis of factors affecting gastrointestinal toxicity from radiation and chemotherapy.
• Evaluation of various antiemetic drug classes and treatment regimens.

Main Results:

• Nausea and vomiting are likely mediated by reduced neurotransmitter breakdown, leading to increased neurotransmitter levels.
• Anticipatory nausea and vomiting can occur, which are not responsive to standard antiemetics but may benefit from behavioral interventions.
• Various antiemetics are effective, including dopamine antagonists, corticosteroids, cannabinoids, and benzodiazepines, with new serotonin antagonists showing promise.

Conclusions:

• Nausea and vomiting are significant challenges in cancer care, potentially leading to treatment refusal.
• Understanding the underlying mechanisms is crucial for developing effective antiemetic strategies.
• Multiagent antiemetic regimens and novel drug classes offer improved management of treatment-induced nausea and vomiting.