Chemotherapy-Induced Nausea and Vomiting

Abstract

Nausea and vomiting (N&V) is among the most distressing side effects of chemotherapy, despite the development of more efficacious antiemetic agents. As many as 60% of patients who receive cancer chemotherapy experience some degree of N&V. However, the actual incidence is difficult to determine with accuracy because of the variety of drugs, doses, and health conditions of the patients who receive cancer treatments. This article examines the state of the science related to chemotherapy-induced nausea and vomiting and reviews both pharmacologic and behavioral strategies that have demonstrated efficacy in managing these distressing symptoms.

Multicenter, phase II, placebo‐controlled, double‐blind, randomized study of aprepitant in Japanese patients receiving high‐dose cisplatin

“…This shows that efficacy was significantly higher in the aprepitant 40 ⁄ 25 mg and 125 ⁄ 80 mg groups than in the standard therapy group (v 2 test [closed testing procedure]: P = 0.0053 and P = 0.0004, respectively) and highest in the aprepitant 125 ⁄ 80 mg group. The delayed phase efficacy (days 2-5) was similar to the overall phase efficacy (days [1][2][3][4][5], indicating that aprepitant is effective in the delayed phase when standard therapy is not very effective. In terms of safety, aprepitant was generally well tolerated in Japanese cancer patients.…”

“…This was a multicenter, placebo-controlled, double-blind, randomized, parallel comparative study and conducted in a total of 127 institutions in Japan. Patients who met all of the inclusion criteria and none of the exclusion criteria were allocated to the aprepitant 125 ⁄ 80 mg group (oral administration at a dose of 125 mg on day 1 and a dose of 80 mg on days 2-5), aprepitant 40 ⁄ 25 mg group (oral administration at a dose of 40 mg on day 1 and a dose of 25 mg on days [2][3][4][5] or the standard therapy group (oral administration of placebo on days [1][2][3][4][5]. Treatment assignment (dynamic allocation) was performed using a minimization method for balancing four factors (sex, presence or absence of at least one emetogenic antitumor agent used in combination with cisplatin, presence or absence of previous treatment with cisplatin, and institution) between the treatment and control groups.…”

“…A total of 453 patients were enrolled. In the three study groups, (i) standard therapy, (ii) aprepitant 40 ⁄ 25 mg (40 mg on day 1 and 25 mg on days 2-5) and (iii) aprepitant 125 ⁄ 80 mg (125 mg on day 1 and 80 mg on days [2][3][4][5], the percentage of patients with complete response (no emesis and no rescue therapy) was 50.3% (75 ⁄ 149 subjects), 66.4% (95 ⁄ 143 subjects) and 70.5% (103 ⁄ 146 subjects), respectively. This shows that efficacy was significantly higher in the aprepitant 40 ⁄ 25 mg and 125 ⁄ 80 mg groups than in the standard therapy group (v 2 test [closed testing procedure]: P = 0.0053 and P = 0.0004, respectively) and highest in the aprepitant 125 ⁄ 80 mg group.…”

“…(Cancer Sci 2010;101: 2455-2461 C hemotherapy-induced nausea and vomiting (CINV) is a common adverse event observed in more than 90% of patients treated with highly emetogenic antitumor agents, especially cisplatin. (1,2) In general, CINV persists for approximately 5 days. (3) The CINV that occurs within 24 h after administration of antitumor agents is defined as acute phase CINV, and delayed phase CINV occurs 2-5 days after administration of antitumor agents.…”

Putting Evidence Into Practice

“…Nausea and vomiting: An estimated 60% of patients who receive chemotherapy as part of their treatment experience some degree of nausea and vomiting (Bender et al 2002). Several types of chemotherapy-induced nausea and vomiting (CINV) exist (Mitchell, 2006).…”