Antiemetic Prophylaxis for Chemotherapy-Induced Nausea and Vomiting

CHEMOTHERAPY-INDUCED NAUSEA AND VOMITING (CHEMOTHERAPY-induced emesis) is a common treatment-related side effect that has a detrimental effect on the quality of life of patients with cancer and may lead to dose reductions in or discontinuation of chemotherapy. The development of new antiemetic agents has dramatically changed the landscape of chemotherapy-induced emesis. In the 1970s, prolonged hospital stays for nausea after chemotherapy were common practice.(1) In 1979, a randomized trial involving patients with cancer showed that the overall incidence of chemotherapy-induced emesis was approximately 83%.(2) Two decades later, with newly available antiemetics, an observational study reported incidences of acute nausea and vomiting of 35% and 13%, respectively, among patients receiving highly and moderately emetogenic chemotherapy. 3 Currently, adherence to antiemetic guidelines provides effective relief from chemotherapy-induced emesis,(4-6) and patients rapidly return to normal daily activities after treatment.(7,8) As a result, the quality of life of patients with cancer has improved, and better control of chemotherapy-induced emesis may help avoid reductions in and discontinuation of chemotherapy. These major advances have been recognized in a worldwide online survey conducted by the American Society of Clinical Oncology (ASCO) in 2014, in which antiemetics were voted by physicians, patients, and the public as one of the Top 5 Advances in 50 Years of Modern Oncology.(9) In this review, we provide background information and the history of the major landmarks in prophylaxis for chemotherapy-induced emesis in adult patients, describe current clinical practices and challenges, and discuss potential approaches to addressing the remaining gaps in the understanding and prevention of chemotherapy-induced emesis.