Chemotherapy-induced nausea and vomiting: current and new standards in the antiemetic prophylaxis and treatment.
Nausea and vomiting are considered as two of the most distressing side-effects of chemotherapy. Chemotherapy-induced nausea and vomiting have been classified into acute, delayed and anticipatory based on the time of onset. The frequency of nausea and vomiting depends primarily on the emetogenic potential of the chemotherapeutic agents used. With the introduction of the 5-HT3 receptor-antagonists in combination with dexamethasone in the early 1990s approximately 70% of patients receiving highly emetogenic chemotherapy were protected from acute emesis. However, 40% of patients have symptoms in the delayed phase. Another group of antiemetics, the neurokinin-1-receptor-antagonists, have recently been introduced. The addition of neurokinin receptor (NK1 receptor)-antagonists to standard therapy significantly improves emesis protection in the acute and in particular in the delayed phase by approximately 20%. Due to these new developments, revised antiemetic guidelines have been set. Here, the most recent developments in antiemetic therapy, including these guidelines, are reviewed.
Jordan
Karin
K
Department of Internal Medicine IV, Haematology/Oncology, Martin-Luther-University Halle/Wittenberg, Ernst-Grube-Str. 40, 06120 Halle/Saale, Germany.
Kasper
Christoph
C
Schmoll
Hans-Joachim
HJ
D000208:Acute Disease; D000932:Antiemetics / Q000592:standards / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000009:adverse effects*; D001569:Benzodiazepines / Q000627:therapeutic use; D002186:Cannabinoids / Q000627:therapeutic use; D018492:Dopamine Antagonists / Q000627:therapeutic use; D006634:Histamine H1 Antagonists / Q000627:therapeutic use; D006801:Humans; D009325:Nausea / Q000139:chemically induced* / Q000517:prevention & control; D064729:Neurokinin-1 Receptor Antagonists; D017410:Practice Guidelines as Topic; D016032:Randomized Controlled Trials as Topic; D013256:Steroids / Q000627:therapeutic use; D014839:Vomiting / Q000139:chemically induced* / Q000517:prevention & control
D000932:Antiemetics; D000970:Antineoplastic Agents; D002186:Cannabinoids; D018492:Dopamine Antagonists; D006634:Histamine H1 Antagonists; D064729:Neurokinin-1 Receptor Antagonists; D013256:Steroids; D001569:Benzodiazepines