[Recent advances in the management of chemotherapy-induced emesis]

Nausea and vomiting induced by cisplatin are very severe and intractable to standard antiemetics. During the past several years, many studies of antiemetic management in the patients receiving cisplatin have been performed. In this paper recent advances in the management of cisplatin-induced emesis were reviewed. To date, high dose (2 mg/kg every 2 hours 3-5 times) metoclopramide is considered to be the most effective drug against emesis induced by high-dose (100-120 mg/m2) cisplatin, and a combination therapy of metoclopramide, dexamethasone, diphenhydramin and lorazepam appears to be the most effective. In antiemetic management the problem of anticipatory emesis and delayed or persistent emesis must be considered as well as acute chemotherapy-induced emesis. On the other hand, we have experienced that antiemetic trials are more ineffective in women than in men, so it is more important to control chemotherapy-induced emesis in women. For obtaining more effective control of cisplatin-induced emesis, a combination of antiemetic agents affecting more than one of several neurotransmitter receptors is necessary. In Japan, antiemetic trials have only strated, so we must make an effort to work towards reducing the distressing emesis induced by cisplatin.