Chemotherapy induced nausea and vomiting prevention and treatment

Department of Medical Oncology, Sir Charles Gairdner Hospital, Nedlands, and School of Medicine and Pharmacology, University of Western Australia, Australia.
Australian family physician (Impact Factor: 0.71). 10/2007; 36(9):702-6.
Source: PubMed


Chemotherapy induced nausea and vomiting are among the most feared consequences of cancer treatment. Recent developments in drug treatment make the goal of no nausea or vomiting during chemotherapy realistic.
In this article we review the pathogenesis and management of chemotherapy induced nausea and vomiting.
Regimens to prevent chemotherapy induced nausea and vomiting are guided by the emetogenic potential of the chemotherapeutic agents used. Combined prophylactic therapy targets different pathways, improving the efficacy of prevention and treatment of chemotherapy induced nausea and vomiting. General practitioners have an important role in patients undergoing chemotherapy by reinforcing the importance of prophylactic treatment and administering rescue treatment for patients with breakthrough or prolonged nausea and vomiting postchemotherapy.

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    • "Since that time, it has been shown that serotonin has important roles in multiple biological systems as a neurotransmitter and a paracrine autacoid factor. Serotonergic dysfunction has been implicated in multiple disease states for which treatments have been developed including depression, obsessivecompulsive disorder, migraine headache, and emesis (Cowen, 2000; Pietrobon, 2003; Mann, 2005; Feeney et al., 2007). Reserpine and ergot alkaloids were two of the first agents, which were used clinically. "

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    ABSTRACT: PurposeAprepitant might offer an advantage in preventing acute/delayed chemotherapy-induced nausea and vomiting (CINV). This study integrated palonosetron and dexamethasone into the regimen to determine the efficacy and safety of this combination.Patients and Methods Fifty patients were enrolled; 49 were evaluable. Main inclusion criteria were (1) diagnosis of ovarian (OV), primary peritoneal (PP), or fallopian tube (FT) carcinoma (stage I-IV) or papillary serous cancer of the uterus (UPSC); (2) patients naive to emetogenic chemotherapy Hesketh ≥ level 4; (3) scheduled to receive paclitaxel 175 mg/m2 intravenously (I.V.) and carboplatin AUC 6 I.V.; able to read/understand the Functional Living Index–Emesis questionnaire.ResultsMedian age was 61 years, 60% had Eastern Cooperative Oncology Group performance status of 0, 86% had previous surgery (74% OV, 12% PP, 8% UPSC, and 6% FT). The metastases rate was 30%; 21% were visceral metastasis. Eighty-six percent of patients reported no vomiting or use of rescue medications during cycle 1 (95% and 100% in cycles 2–3 and 4–6, respectively) and were deemed as complete responders. Grade 3/4 treatment-related adverse events limited to neutropenia (6%). Grade 1/2 toxicities > 5% included nausea (12%), alopecia, constipation, arthralgia (8% each), and anemia (6%). Some toxicities might have been related to chemotherapy and were not related to the aprepitant, palonosetron, or dexamethasone.Conclusion The addition of aprepitant to palonosetron and dexamethasone appears to be very well tolerated. This combination is effective in the prevention of chemotherapy-induced nausea and vomiting when used with emetogenic therapy (paclitaxel and carboplatin).
    Clinical Ovarian Cancer 06/2008; 1(1):60-65. DOI:10.3816/COC.2008.n.006
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    ABSTRACT: In recent years, geriatricians and oncologists have worked together to evaluate elderly patients with cancer before and during treatment, to estimate the balance between the efficacy and safety of chemotherapy and to upgrade treatment in this population according to their comorbidity and physiological status. The clinical and biological factors of this population need to be assessed in multidisciplinary comprehensive geriatric assessment (CGA) in order to optimize treatment without inducing major adverse effects. We reviewed the nutritional aspects of this evaluation that highlight the impact of undernutrition on poor survival. In this paper we briefly describe tumoral cachexia (molecular and physiological), the impact of undernutrition on cancer prognosis (predictive factors), therapeutic effects of cancer on nutritional status, nutritional indicators (biological, anthropometric) and undernutrition in the elderly (specific needs of this population). The potential for nutritional intervention in geriatric oncology with regard to CGA is explored.
    Critical Reviews in Oncology/Hematology 07/2008; 67(3):243-54. DOI:10.1016/j.critrevonc.2008.04.005 · 4.03 Impact Factor
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