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Treatment of Chemotherapy-induced Nausea and Vomiting

Current therapies for chemotherapy-induced nausea and vomiting (CINV)

Blocking the receptors involved in the emesis pathway at the gastrointestinal tract's chemoreceptor trigger zone (e.g. 5-HT3), can target CINV at multiple levels.1

A number of treatments for CINV are currently on the market in the UK, including 5-HT3 receptor antagonists and corticosteroids. Different formulations are available for some of these treatments, including oral (tablets, capsules, melt, syrup), intravenous or intramuscular injections and infusions, suppositories and transdermal patches.2

Generally, healthcare professionals follow a consistent CINV prevention strategy. The number of days, treatment agents and their formulations prescribed depend on benefit/risk factors, chemotherapy regimen, previous response, etc.

An illustrative example of a current strategy is shown below:

Oral antiemetic therapies

Oral agents are a frequent component of antiemetic therapy, yet a number of patients may find it dificult to take oral medication.

Many chemotherapy drugs are associated with the development of oral mucositis, and patients with oral mucositis may find swallowing dificult.3 Swallowing dificulties may also be experienced by head and neck cancer patients following surgery or treatment with radiotherapy or due to the location of their tumour.4

In addition, some patients may have an inability to keep medication down, and therefore not absorb the full dose, or have a reluctance to swallowing medication. Oral therapy also requires an intact gastrointestinal tract – this may be impacted by surgery for certain types of cancer.5

Average:

  • References

    1. Feyer P, Jordan K. Update and new trends in antiemetic therapy: the continuing need for novel therapies. Ann Oncol. 2011;22:30-38.

    2. eMIMS. June 2021.

    3. Kostler WJ et al. Oral mucositis complication chemotherapy and/or radiotherapy: options for prevention and treatment. CA Cancer J Clin. 2001;51:290-315

    4. NICE. Improving outcomes in Head and neck cancers. Available at: https://www.nice.org.uk/guidance/csg6/ Last accessed: June 2023.

    5. Kris MG et al. Consensus recommendations for the prevention of vomiting and nausea following high-emetic-risk chemotherapy. Support Cancer Care. 2011;19.Suppl 1:s25-s32.

    KKI/GB/IM-M1/0001 November 2023