title: Breakthrough chemotherapy-induced nausea and vomiting: report of a nationwide survey by the CINV Study Group of Japan.
abstract: BACKGROUND
  We conducted a nationwide survey on chemotherapy-induced nausea and vomiting (CINV) in Japan and demonstrated good compliance with Japanese CINV guidelines, resulting in good control of vomiting. However, almost half the patients experienced breakthrough CINV. We analyzed the survey results in relationship to the management of patients with breakthrough CINV.
  
  
  METHODS
  This multicenter, prospective, observational study analyzed data for 1910 patients in Japan scheduled for moderately or highly emetogenic chemotherapy (MEC and HEC, respectively). Patients who developed CINV despite prophylactic use of antiemetics were administered rescue drugs. Patients who received cisplatin-based HEC (C-HEC), non-cisplatin-based HEC (N-HEC), or MEC were evaluated separately.
  
  
  RESULTS
  A total of 989 patients experienced CINV, of whom 412 (44%) received rescue antiemetics during the study period. The rate at which patients with breakthrough CINV were started on rescue drugs ranged from 13% to 24%. Rescue drugs were given more frequently on days 2-4 for C-HEC and MEC and on days 1-2 for N-HEC. Eighty-six percent of patients received metoclopramide or domperidone. 5-HT3receptor antagonists, antipsychotics, and anti-anxiety drugs were used for 11-5% of patients. The mean duration of antiemetic use was 2.6 days.
  
  
  CONCLUSIONS
  Fewer than half of the patients with breakthrough CINV were treated with rescue antiemetics, suggesting that CINV was mild in the remaining patients. However, CINV was sufficiently severe to prevent eating in other patients, indicating the need for new drugs with different mechanisms to control CINV.
authors.affiliation: General Medical Research Center, Fukuoka University, 7-45-1, Nanakuma, Jonan-ku, Fukuoka-shi, Fukuoka, 814-0180, Japan. ktamura@fukuoka-u.ac.jp.
authors.forename: Kazuo
authors.identifier: http://orcid.org/0000-0002-2720-9774
authors.initials: K
authors.lastname: Tamura
authors.affiliation: Division of Clinical Oncology/Hematology, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8, Nishi-shimbashi, Minato-ku, Tokyo, 105-8461, Japan.
authors.forename: Keisuke
authors.initials: K
authors.lastname: Aiba
authors.affiliation: Department of Breast Oncology Service, Saitama Medical University International Medical Center, 1397-1, Yamane, Hidaka-shi, Saitama, 350-1298, Japan.
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Saeki
authors.affiliation: Research Institute for Diseases of the Chest, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka-shi, Fukuoka, 812-8582, Japan.
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Nakanishi
authors.affiliation: Medical Care and Education Research Foundation, Yanagawa Hospital, 29, Chikushi-machi, Yanagawa-shi, Fukuoka, 832-0077, Japan.
authors.forename: Toshiharu
authors.initials: T
authors.lastname: Kamura
authors.affiliation: Department of Gastroenterological Surgery, Kumamoto University, 1-1-1, Honjomachi, Chuo-ku, Kumamoto-shi, Kumamoto, 860-0811, Japan.
authors.forename: Hideo
authors.initials: H
authors.lastname: Baba
authors.affiliation: Department of Surgical Oncology, Gifu University, 1-1, Yanagito, Gifu-shi, Gifu, 501-1194, Japan.
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Yoshida
authors.affiliation: Third Lecture of Internal Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama-shi, Wakayama, 641-8509, Japan.
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Yamamoto
authors.affiliation: Department of Surgery, School of Medicine, Keio University, 35, Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
authors.forename: Yuko
authors.initials: Y
authors.lastname: Kitagawa
authors.affiliation: Department of Surgery and Science, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka-shi, Fukuoka, 812-8582, Japan.
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Maehara
authors.affiliation: Cancer Biostatistics Laboratory, Clinical Research Institute, National Hospital Organization Kyushu Cancer Center, 3-1-1, Notame, Minami-ku, Fukuoka-shi, Fukuoka, 811-1395, Japan.
authors.forename: Mototsugu
authors.initials: M
authors.lastname: Shimokawa
authors.affiliation: JR Sapporo Hospital, N3 E1, Chuo-ku, Sapporo-shi, Hokkaido, 060-0033, Japan.
authors.forename: Koichi
authors.initials: K
authors.lastname: Hirata
authors.affiliation: International University of Health and Welfare, Amity Nogizaka Bldg. 1-24-1 Minami-Aoyama, Minato-Ku, Tokyo, 107-0062, Japan.
authors.forename: Masaki
authors.initials: M
authors.lastname: Kitajima
mesh_terms: D000932:Antiemetics / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000009:adverse effects*; D005260:Female; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009325:Nausea / Q000139:chemically induced / Q000453:epidemiology / Q000517:prevention & control*; D009369:Neoplasms / Q000188:drug therapy*; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D014839:Vomiting / Q000139:chemically induced / Q000453:epidemiology / Q000517:prevention & control*
chemical_list: D000932:Antiemetics; D000970:Antineoplastic Agents
keywords: Antiemetic; Breakthrough; Chemotherapy; Nausea; Vomiting