Management of Chemotherapy Induced Nausea and Vomiting in Patients on Multiday Cisplatin Based Combination Chemotherapy

Introduction of cisplatin based chemotherapy has revolutionized the treatment of germ cell tumors. A common side effect of multiday cisplatin chemotherapy is severe nausea and vomiting. Considerable progress has been made in the control of these side effects since the introduction of cisplatin based chemotherapy in the 1970s. Germ cell tumor which is a model for a curable neoplasmhas also turned into an excellent testing ground to develop effective strategies to prevent chemotherapy induced nausea and vomiting (CINV) in multiday cisplatin based regimens. The use of combination of a 5-hydroxytryptamine (HT) 3 receptor antagonist, a neurokinin-1 (NK 1) antagonist, and dexamethasone has greatly improved our ability to prevent and control acute and delayedCINV. MechanismandpatternofCINVwithmultiday chemotherapymaydiffer fromthose in single day chemotherapy and therefore efficacy of antiemetic drugs as observed in single day chemotherapymay not be applicable. There are only few randomized clinical trials with special emphasis onmultiday chemotherapy. Further studies are essential to determine the efficacy, optimal dose, and duration of the newer agents and combinations in multiday cisplatin based chemotherapy.