Possible role of aprepitant for intractable nausea and vomiting following whole brain radiotherapy-a case report

Radiation-induced nausea and vomiting (RINV) is one of the most distressing symptoms that adversely affects quality of life (QOL) as well as the ongoing management plan of cancer patients. Although there are protocols for management of chemotherapy induced nausea and vomiting (CINV) but such guidelines are still lacking for RINV. Various agents like 5-hydroxy tryptophan 3 (5-HT3) antagonist, dexamethasone, metoclopramide and haloperidol are used in clinical practice for RINV but the results are not very encouraging. Because of proposed similarity in the mechanism of nausea and vomiting following chemotherapy and radiotherapy, aprepitant, a substance P neurokinin 1 receptor antagonist can be an optimal agent for RINV on account of its unique pharmacological property. We report a case of metastatic carcinoma breast with bilateral cerebellar metastasis. She presented with complaints of headache and intractable nausea and vomiting. A single fraction whole brain radiotherapy (WBRT) was given for bilateral cerebellum metastasis which further precipitated her symptoms. The prophylactic and therapeutic efficacy of antiemetic used for RINV may be enhanced by adding aprepitant before starting radiotherapy in high risk cases as in ours.