Reviewing current and emerging antiemetics for chemotherapy-induced nausea and vomiting prophylaxis

Abstract

This review provides background information on chemotherapy-induced nausea and vomiting (CINV) classification and pathophysiology and reviews various antiemetic agents for CINV prophylaxis, including corticosteroids, serotonin receptor antagonists (5-HT3 RAs), tachykinin NK1 receptor antagonists (NK1 RAs), and olanzapine. Other less commonly used agents are briefly discussed. Practical considerations are reviewed as well, including emetogenicity of chemotherapeutic regimens, patient-specific risk factors for CINV, principles of CINV management, health economics outcome research, and quality of life. Available data on the newly FDA-approved antiemetic combination netupitant/palonosetron (NEPA) is also reviewed. Prevention of CINV is an important goal in managing patients with cancer and is especially difficult with respect to nausea and delayed CINV. Corticosteroids are a mainstay of CINV prophylaxis and are usually given in combination with other therapies. The 5-HT3 RA palonosetron has shown increased efficacy over other agents in the same class for prevention of delayed emesis with moderately emetogenic chemotherapy and NK1 RAs improve emesis prevention in combination with 5-HT3 RAs and dexamethasone. Olanzapine has shown efficacy for CINV prophylaxis and the treatment of breakthrough CINV. The new combination therapy, NEPA, has been shown to be efficacious for the prevention of acute, delayed, and overall CINV. Risk factors that have been identified for CINV include gender, age, and alcohol intake. It is important to assess the emetogenicity of chemotherapy regimens as well as the potential impact of patient risk factors in order to provide adequate prophylaxis. Acute and delayed CINV are severe, burdensome side effects of chemotherapy; however, new data on prevention and the discovery of new agents can further improve CINV control.

Avaliação de náusea e êmese em pacientes sob quimioterapia em uma Unidade de Alta Complexidade Saúde de Vitória da Conquista/BA

“…Metanálise mostrou melhora significativa na prevenção de êmese aguda e tardia, em combinação com antagonista de 5-HT e dexametasona para quimioterapia moderadamente e altamente emetogênica (p <0,001) 4 .…”

“…Deve-se levar em consideração também os vieses de memória e informação no estudo, visto que as respostas ao questionário dependiam da lembrança do paciente da ocorrência desses episódios 4 . Cumpre ressaltar que as associações entre o desfecho e as variáveis explicativas não puderam ser realizadas em virtude da amostra restrita.…”

“…As diretrizes da NCCN recomendam seu uso nos dias 1-3 pós-ciclo para um único dia de quimioterapia moderadamente emetogênica e 1-4 dias para um único dia de quimioterapia altamente emetogênica, em combinação com dexametasona e antagonista de 5-HT no primeiro dia 4 .…”

“…As náuseas e vômitos tardios, em particular, muitas vezes são mais refratários ao tratamento e de difícil estimativa, devido à subnotificação do paciente e baixa adesão à terapia antiemética 4 .…”

Detection of Nausea-Like Response in Rats by Monitoring Facial Expression

“…To reduce these symptoms, serotonin 5-HT 3 receptor antagonists, neurokinin NK 1 receptor antagonists, and corticosteroids are used (Jordan et al, 2015; Natale, 2015; Einhorn et al, 2016; Navari and Aapro, 2016). This regimen proved to be significantly effective, but patients still experience nausea, especially delayed nausea (Molassiotis et al, 2008; Farrell et al, 2013).…”