Control of cancer chemotherapy-induced nausea and vomiting

With increasingly effective cancer chemotherapy, the control of chemotherapy-induced nausea and vomiting has become more important. These unpleasant side effects can be so severe that patients delay or stop potentially curative therapy. Phenothiazines and butyrophenones have been the mainstays of most antiemetic therapy but unfortunately have only partially controlled nausea and vomiting. Recently, renewed interest in the control of nausea and vomiting has led to the introduction of additional classes of agents. Cannabinoids appear to be superior to phenothiazines as antiemetics, but must be given in doses that also cause central nervous system side effects. Metoclopramide, given in high doses (1.0-3.0 mg/kg) has proven to be a major advance in the control of nausea and vomiting induced by cisplatin. Glucocorticoids may be useful, particularly when combined with other agents. There has been recent recognition of the importance of anticipatory nausea and vomiting, and attempts to control this through behavioral modification techniques have met with some success.