title: New options and controversies in the management of chemotherapy-induced nausea and vomiting.
abstract: OBJECTIVE
  An expanding array of options for prevention and treatment of chemotherapy-induced nausea and vomiting (CINV), including regimens containing olanzapine or recently approved neurokinin 1 (NK1) receptor antagonists, are reviewed.
  
  
  CONCLUSIONS
  Up to 80% of patients receiving chemotherapy have CINV. Current practice guidelines recommend that patients treated with highly emetogenic chemotherapy also receive a 3-drug antiemetic regimen initiated on the day of and continued for 3 days after chemotherapy administration, with the most commonly used 3-drug regimen consisting of an NK1receptor antagonist, a 5-hydroxytryptamine type 3 (5-HT3) receptor antagonist, and dexamethasone. Developments in the area of CINV management in recent years include the use of olanzapine in combination with a 5-HT3antagonist and dexamethasone; Food and Drug Administration (FDA) approval of the NK1receptor antagonist rolapitant, which provides a longer duration of effect than aprepitant; FDA approval of a combination product containing palonosetron and the NK1receptor antagonist netupitant; and revisions of U.S. practice guidelines ending palonosetron's status as the preferred 5-HT3antagonist for prevention of CINV associated with moderately or highly emetogenic chemotherapy.
  
  
  CONCLUSIONS
  Newer therapeutic options for the management of CINV are equivalent to standard-of-care regimens in terms of efficacy and toxicity. While the NK1receptor antagonist rolapitant and a product combining palonosetron and netupitant have potential advantages over standard therapy in terms of convenience or pharmacologic properties, their relatively high costs must be considered.
authors.affiliation: UW Health, Madison, WI.
authors.forename: Sara M
authors.initials: SM
authors.lastname: Koth
authors.affiliation: College of Pharmacy, University of Kentucky, Lexington, KY. jill.kolesar@uky.edu.
authors.forename: Jill
authors.initials: J
authors.lastname: Kolesar
mesh_terms: D000932:Antiemetics / Q000627:therapeutic use; D006801:Humans; D009325:Nausea / Q000139:chemically induced* / Q000517:prevention & control; D064729:Neurokinin-1 Receptor Antagonists / Q000627:therapeutic use; D000077152:Olanzapine / Q000627:therapeutic use; D012702:Serotonin Antagonists / Q000627:therapeutic use; D014839:Vomiting / Q000139:chemically induced* / Q000517:prevention & control
chemical_list: D000932:Antiemetics; D064729:Neurokinin-1 Receptor Antagonists; D012702:Serotonin Antagonists; D000077152:Olanzapine
keywords: NK receptor anatagonists; chemotherapy-induced nausea and vomiting; serotonin receptor antagonists