Antiemetic therapy options for chemotherapy-induced nausea and vomiting in breast cancer patients

Abstract

Chemotherapy-induced nausea and vomiting (CINV) continues to be one of the most distressing side effects of chemotherapy in breast cancer patients, which can result in poor compliance to therapy that may, in turn, affect overall survival. The extent of CINV is dependent on the emetogenic potential of the individual cytotoxic agents or regimens employed as well as certain patient factors. Advances in our understanding in the pathophysiology of CINV and the identification of risk factors have enabled the utilization of appropriate antiemetic regimens to improve the control of CINV. Most of the chemotherapy regimens used in this patient population are considered to be moderately emetogenic; 60%-90% of chemotherapeutic regimens used in breast cancer patients cause nausea and vomiting, amongst which regimens doxorubicin-cyclophosphamide (AC) combination is commonly regarded as of relatively higher emetogenicity. Currently, corticosteroids, 5-hydroxytryptamine 3 (5-HT3) receptor antagonists, and neurokinin 1 (NK-1) receptor antagonists are the three classes of antiemetic agents with the highest therapeutic index, which have been supported by data from large-scale randomized clinical trials. Treatment guidelines enable physicians to integrate the latest research data into their clinical practices. This review focuses on the three classes of antiemetic therapy options for CINV in breast cancer patients, as well as their safety and tolerability profiles. Recommendations from major guidelines/consensus including from the Multinational Association for Supportive Care in Cancer/European Society of Medical Oncology (MASCC/ESMO), the American Society of Clinical Oncology (ASCO), and the US National Comprehensive Cancer Network (NCCN), are also discussed. With the correct use of antiemetic regimens, chemotherapy-induced vomiting could be prevented in the majority of patients. However, chemotherapy-induced nausea remains an important symptom and a challenge for physicians to manage.

Effect of acupuncture in prevention and treatment of chemotherapy-induced nausea and vomiting in patients with advanced cancer: study protocol for a randomized controlled trial

“…The most important influencing factor for CINV is the chemotherapy regimen. The severity and incidence of CINV are usually determined by chemotherapeutic agent, dosage, combinations with other treatment approaches, and patient characteristics [ 2 – 4 ]. Patient-related variables that influence the risk of CINV include age (persons younger than 50 years old tend to experience more CINV), sex (females have a high risk of CINV), history of low prior chronic alcohol intake, history of previous chemotherapy-induced emesis, and others [ 5 ].…”

Current Evidence on Auricular Therapy for Chemotherapy‐Induced Nausea and Vomiting in Cancer Patients: A Systematic Review of Randomized Controlled Trials

“…Chemotherapy-induced nausea and vomiting (CINV) is one of the most common and distressing side effects among cancer patients, and the severity and incidence of CINV are usually determined by the particular chemotherapeutic agent, dosage, combinations with other treatment approaches, and patient characteristics [ 1 – 3 ]. Some of the most commonly used regimens, such as cisplatin or cyclophosphamide, are regarded to be of moderate to high emetic potential, respectively [ 3 , 4 ], which can have a significant negative impact on patients' health status.…”

“…The most popular approach applied for controlling CINV nowadays is the regular use of antiemetic drugs. Of which, 5-HT 3 receptor antagonists, NK-1 receptor antagonists, and corticosteroids are identified as first-line treatment [ 1 ]. However, even with the help of antiemetics, nearly half of cancer patients receiving moderate to high emetic chemotherapy still experience some CINV, particularly delayed nausea and vomiting [ 10 ].…”

Synergistic drug combinations from electronic health records and gene expression

“…In the estrogen receptor or progesterone receptor positive group, our model identified synergistic pairs of antiestrogens or aromatase inhibitors with antiemetics (eg, ondansetron, granisetron), possibly due to the increased tolerance afforded by the antiemetics. 42 Among human epidermal growth factor receptor 2–positive patients, who often have worse prognoses than other hormone-sensitive subtypes, several synergistic pairs included phenazopyridine, which might have been prescribed to relieve urethral discomfort from aggressive estrogen suppression. Rediscovering such coprescription patterns known to alleviate side effects suggests that our approach can uncover beneficial combinations.…”