[Antiemetic treatment and chemotherapy: general review]

Chemotherapy-induced nausea and emesis are frequent and patients fearful. Emesis caused by cytotoxic agents can be related to their effects on central chemoreceptor or on the gut chemoreceptor by serotonin. 5HT3 receptor antagonists produce a major improvement in the control of cisplatin induced-emesis (70 to 80% of patients). The 5HT3-antagonist efficacy is significantly better than metoclopramide alone, or antimemetic combinations in highly emetogenic chemotherapy regimens but less good in moderately emetogenic chemotherapy. Studies with 5HT3 receptor antagonist plus corticosteroids show advantage over 5HT3 antagonist alone. Comparison studies between the different setrons didn't show any significant difference. Anticipary emesis are treated with anxiolytic drugs. The prevention of delayed emesis, not yet well controlled by 5HT3 antagonist, is a great therapeutic deal. Finally, some therapeutic problems are not resolved: minimal dose, use of oral route, efficacy in fractionated chemotherapy, treatment after loss of efficacy of 5HT3 antagonist.