Nausea and Vomiting
Summary of Key Points
Treatment
• Optimal treatment provides complete control of acute nausea and vomiting in the majority of patients receiving chemotherapy; only 15% of patients receiving highly emetogenic chemotherapy regimens have severe nausea and vomiting
• Treatment of delayed nausea and vomiting has improved with the introduction of aprepitant and palonosetron; this complication can now be completely controlled in two thirds of patients
1. Which of the following patient factors is not related to the incidence and severity of chemotherapy-induced nausea and vomiting?
2. Which moderately emetogenic regimen requires routine prophylaxis for delayed nausea and vomiting?
3. Which 5-hydroxytryptamine 3 (5-HT3) receptor antagonist is most effective in preventing acute nausea and vomiting?
4. In patients with anticipatory nausea and high anxiety level, which of the following agents has been helpful?
5. A 60-year-old man with metastatic bladder cancer is scheduled to receive treatment with cisplatin (80 mg/m2) and gemcitabine. A 5-HT3 receptor antagonist will be included in his antiemetic prophylaxis. What other antiemetic should routinely be included?
1. Answer: C. Several patient factors including female gender, young age, and no history of alcohol use are correlated with higher risk for chemotherapy-induced nausea and vomiting. Weight is not a risk factor.
2. Answer: B. Regimens containing cyclophosphamide and an anthracycline have a higher incidence of delayed nausea and vomiting than other regimens that are moderately emetogenic (for acute nausea/vomiting). Aprepitant decreases the incidence of delayed nausea/vomiting after administration of cyclophosphamide/doxorubicin and should be a routine part of antiemetic prophylaxis.
3. Answer: D. Multiple randomized trials showed equivalent efficacy of the three “first-generation” 5-HT3 receptor antagonists (ondansetron, granisetron, and dolasetron). Palonosetron has shown better control of acute nausea/vomiting when compared with the other agents in phase 3 trials.
4. Answer: C. Lorazepam is the only agent that has shown efficacy in reducing anticipatory nausea/vomiting.
5. Answer: B. Dexamethasone improves antiemetic efficacy and should be included in all situations in which a 5-HT3 receptor antagonist is prescribed, unless there are specific contraindications to corticosteroid use. Because cisplatin has a high risk of causing delayed nausea and vomiting, aprepitant should also be added to the regimen.
