ABSTRACT
The goal of each antiemetic therapy is to abolish nausea and vomiting. Twenty years
ago, nausea and vomiting were common adverse events of certain types of che-
motherapy and forced up to 20% of patients to postpone or refuse potentially
curative treatment (1). Clinical and basic research over the past 25 years has lead to
steady improvements in the control of chemotherapy-induced nausea and vomiting
(CINV). The development of the 5-HT3-receptor antagonists (5-HT3-RAs) in the
early 1990s has been one of the most significant advances in chemotherapy of
cancer patients. Corticosteroids are often underestimated although they show when
combinedwith other antiemetic agents good antiemetic efficacy in the prevention of
acute and delayed CINV. Another group of antiemetics, the neurokinin-1-receptor
antagonists (NK1-RA), has recently been developed, and the first drug in this class,
aprepitant, was incorporated in the updated antiemetic guidelines by the American
Society of Clinical Oncology (ASCO), Multinational Association of Supportive
Care in Cancer (MASCC), and National Comprehensive Cancer Network (NCCN).
Classification of CINV: Acute/Delayed/Anticipatory Nausea and Vomiting
CINV may be classified into three categories: acute onset, occurring within
24 hours of initial administration of chemotherapy (mostly serotonin-related);
delayed onset, occurring 24 hours to several days after initial treatment (mostly
Substance P related); and anticipatory nausea and vomiting, observed in patients
whose emetic episodes are triggered by taste, odor sight, thoughts, or anxiety,
secondary to a history of poor response to antiemetic agents (Table 1).
