Cancer Chemotherapy Associated Nausea and Vomiting Therapeutics most common and distressing side effects
Chemotherapy induced nausea and vomiting (CINV) is one of the most common and distressing side effects experienced by cancer patients undergoing chemotherapy. The mechanisms involved in chemotherapy-induced nausea and vomiting are complex. Chemotherapy causes damage to cells in the gastrointestinal tract. This leads to the release of neurotransmitters such as substance P and serotonin from the gastrointestinal tract. These neurotransmitters act on receptors in the chemoreceptor trigger zone (CTZ), a vomiting center located in the medulla oblongata region of the brainstem. The CTZ then signals the vomiting center to induce nausea and vomiting.
The Cancer Chemotherapy Associated Nausea And Vomiting Therapeutics agents is classified based on their risk of causing CINV. Highly emetogenic chemotherapy (HEC) has a 90% or greater risk of causing vomiting in absence of antiemetic treatment. Moderately emetogenic chemotherapy (MEC) has 30-90% risk and low emetogenic chemotherapy (LEC) has less than 30% risk. Platinum-based regimens like cisplatin are examples of HEC while carboplatin is MEC. Anthracyclines like doxorubicin have intermediate emetic risk between MEC and LEC.
Guidelines for Prophylaxis and Treatment of CINV
The Multinational Association for Supportive Care in Cancer and the American Society of Clinical Oncology have published clinical practice guidelines for antiemetic treatment of chemotherapy-induced nausea and vomiting. These guidelines recommend a three drug combination of a 5-HT3 receptor antagonist, a neurokinin-1 receptor antagonist, and dexamethasone for HEC and a two drug combination for MEC.
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