Nausea and vomiting associated with chemotherapy and principles of management in their prevention
DOI:
https://doi.org/10.56782/pps.227Keywords:
vomiting, nausea, chemotherapy, guidelines, glucocorticosteroidsAbstract
Nowadays, there are many effective cancer treatments that use different combinations of chemotherapeutics agents to destroy cancer cells, often in advanced stages when radical surgery methods are no longer possible. Unfortunately, the toxicity of treatment can cause many side effects. One of them is nausea and vomiting, which significantly affects the quality of life and is a challenge for cancer patients. Nausea and vomiting affect 40-80% of patients receiving chemotherapy and/or radiotherapy. The likelihood of their occurrence depends on the treatment regimen, dose and route of administration. Of course, patient-related factors also play a role. The use of combination antiemetics, including setrons in combination with a neurokinin-1 (NK-1) receptor antagonist and glucocorticosteroids, can effectively prevent nausea and vomiting - in the early type in about 80-90% of patients and in the late type in about 60-80%. Nausea and vomiting can significantly reduce the quality of life of patents undergoing cancer treatment. However, adherence to an appropriate treatment regimen ensures that patients have an optimal quality of life during treatment. This article discusses current strategies for the prevention and treatment of nausea and vomiting using antiemetic drugs.
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References
1. Wojtyniak, B.; Goryński, P. Health Status of Polish Population and Its Determinants 2022. National Institute of Public Health NIH – National Research Institute: Warsaw, Poland, 2022, pp. 271-292.
2. Wojciechowska, U.; Barańska, K.; Michałek, I.; Olasek, P.; Miklewska, M.; Didkowska, J. Nowotwory złośliwe w Polsce w 2020 roku [Cancer in Poland in 2020]. Krajowy Rejestr Nowotworów, Narodowy Instytut Onkologii [National Cancer Registry, National Cancer Institute]: Warsaw, Poland, 2022; p. 3.
3. National Cancer Registry. Available online: https://onkologia.org.pl/pl/nowotwory/leczenie (accessed on 01.08.2023)
4. Strąg-Lemanowicz, A.; Leppert, W. The role of oncologic systemic treatment in patients with advanced cancer. Palliat. Med. Pract. 2014, 8, 11 – 22.
5. Rubach, M. Objawy niepożądane chemioterapii (cz. 1) [Adverse effects of chemotherapy]. Onkologia po Dyplomie [Oncology after the diploma] 2019, 04. Available online: https://podyplomie.pl/onkologia/33141,objawy-niepozadane-chemioterapii-cz-1?srsltid=AfmBOopjhspw1GFq4R639Mau_5MsDEOQA9-a3cN0Tws9KMWSwxGMc-m9 (accessed 02.08.2023)
6. Kawecki, A.; Krzakowski, M. Chemotherapy and radiotherapy induced nausea and vomiting. Oncol. Clin. Pract. 2018, 14, 53–61. DOI: 10.5603/OCP.2018.0010, copyright
7. Sullivan, J.R.; Leyden, M,J.; Bell, R. Decreased cisplatin-induced nausea and vomiting with chronic alcohol ingestion. N. Engl. J. Med. 1983, 309, 796-796. DOI: 10.1056/NEJM198309293091317 DOI: https://doi.org/10.1056/NEJM198309293091316
8. Tonato, M.; Roila, F.; Del Favero, A. Methodology of antiemetic trials: a review. Ann. Oncol. 1991, 2, 107-114. DOI: 10.1093/oxfordjournals.annonc.a057871 DOI: https://doi.org/10.1093/oxfordjournals.annonc.a057871
9. Hesketh, P.J.; Kris, M.G.; Basch, E.; et al. Antiemetics: American Society of Clinical Oncology Clinical Practice Guideline Update. J. Clin. Oncol. 2017, 35, 3240-3261. DOI: 10.1200/JCO.2017.74.4789 DOI: https://doi.org/10.1200/JCO.2017.74.4789
10. Szczeklik, A; Gajewski P. Nausea and vomiting. In Szczeklik's Interna: small textbook 2022/2023, 14nd ed.; Krzakowski, M.; Sacha, T.; Krzemieniecki, K.; Practical Medicine: Cracow, Poland, 2022.
11. Mannix, K.A.; Hardy, J.R.; Glare, P.; Yates, P. Palliation of nausea and vomiting. In Oxford Textbook of Palliative Medicine, 5th ed.; Cherny, N.I.; Fallon, M.T.; Kaasa, S.; Portenoy, R.K.; Currow, D.C., Eds.; Oxford University Press: Oxford, UK, 2015, pp. 661-675. DOI: https://doi.org/10.1093/med/9780199656097.003.0202
12. Ripamonti, C.; Bruera, E. Chronic nausea and vomiting. In Gastrointestinal Symptoms in Advanced Cancer Patients, 1st ed.; Ripamonti, C.; Bruera, E., Eds.; Oxford University Press: Oxford, UK, 2002, pp. 169-192. DOI: https://doi.org/10.1093/oso/9780192632845.003.0008
13. Roila, F.; Molassiotis, A.; Herrstedt, J.; et al. 2016 MASCC and ESMO guideline update for the prevention of chemotherapy- and radiotherapy-induced nausea and vomiting and of nausea and vomiting in advanced cancer patients. Ann. Oncol. 2016, 27, 119–133, DOI: 10.1093/annonc/mdw270 DOI: https://doi.org/10.1093/annonc/mdw270
14. Sutherland, A.; Naessens, K.; Plugge, E.; Ware, L.; Head, K.; Burton, M.J.; Wee, B. Olanzapine in the prevention and treatment of vomiting and nausea associated with cancer in adults. Cochrane Database Syst. Rev. 2018, 9, Art. No: CD012555. DOI: 10.1002/14651858.CD012555.pub2 DOI: https://doi.org/10.1002/14651858.CD012555.pub2
15. Leppert, W.; Łuczak, J. Treatment of nausea and vomiting in advanced cancer, Contemp. Oncol. 2003, 7, 504–527
16. Piechal, A.; Blecharz-Kliin, K. Leki przeciwwymiotne [Antiemetics]. Medycyna po dyplomie [Medicine after the diploma] 2014, 03. Available online: https://podyplomie.pl/medycyna/16197,leki-przeciwwymiotne?srsltid=AfmBOopYQdutkcUZHAegLUKekNZVHEIZWTRiYHXNEmd7Fz1Vl9KlODwU (accessed 03.08.2023)
17. Gilmore, J.; D’Amato, S.; et al. Recent yadvances in antiemetics: new formulations of 5HT3-receptor antagonists. Cancer Manag. Res. 2018, 10, 1827-1857. DOI: 10.2147/CMAR.S166912 DOI: https://doi.org/10.2147/CMAR.S166912
18. Dadej, A.; Dadej, D.; Michałowska, M.; Tomczak, Sz.; Zając, M.; Jelińska, A. Antagonists of 5-HT3 serotonin and NK-1 neurokinin receptors in the management of chemotherapy-related early and late vomiting. Mod. Pharm. 2019, 12, 134-141.
19. Scannell, C.; Ryan, A.; Power, D.; Hanna, M.; O’Sullivan, A.; Mulcahy, K.; Dolan, O. The Truth Behind Food & Cancer: Simple Explanations Based on Scientific Evidence; 1st ed.; Cork University Press: Cork, Ireland, 2022, pp. 34-36. DOI: https://doi.org/10.33178/boolean.2022.1.24
20. Leppert, W.; Wache A. Nudności i wymioty wywołane chemioterapią i radioterapią u chorych na nowotwory [Nausea and vomiting induced by chemotherapy and radiotherapy in cancer patients]. Onkologia po dyplomie [Oncology after the diploma]. 2014, 05. Available online: https://podyplomie.pl/onkologia/17162,nudnosci-i-wymioty-wywolane-chemioterapia-i-radioterapia-u-chorych-na-nowotwory?srsltid=AfmBOookfMVtBW7dauIcZ8Z9_R5w_RxOBX_hXjOHH_mi9HoyqqqiuHFl (accessed 02.08.2023).
21. Rao, K.V.; Faso, A. Chemotherapy-induced nausea and vomiting: optimizing prevention and management. Am. Health Drug Benefits. 2012, 5, 232-240.
22. Dennis, K.; Maranzano, E.; De Angelis, C.; et al. Radiotherapy-induced nausea and vomiting. Expert Rev. Pharmacoecon. Outcomes Res. 2011, 11, 685-692. Doi: 10.1586/erp.11.77 DOI: https://doi.org/10.1586/erp.11.77
23. Maranzano, E.; De Angelis, V.; Pergolizzi, S.; et al. A prospective observational trial on emesis in radiotherapy: analysis of 1020 patients recruited in 45 Italian radiation oncology centres. Radiother. Oncol. 2010, 94, 36-41. DOi: 10.1016/j.radonc.2009.11.001 DOI: https://doi.org/10.1016/j.radonc.2009.11.001
24. Horiot, J.C. Prophylaxis versus treatment: is there a better way to manage radiotherapy-induced nausea and vomiting? Int. J. Radiat. Oncol. Biol. Phys. 2004, 60, 1018-1025. DOI: 10.1016/j.ijrobp.2004.07.722 DOI: https://doi.org/10.1016/j.ijrobp.2004.07.722
25. Aass, N.; Håtun, D.E.; Thoresen, M.; et al. Prophylactic use of tropisetron or metoclopramide during adjuvant abdominal radiotherapy of seminoma stage I: a randomised, open trial in 23 patients. Radiother. Oncol. 1997, 45, 125-128. DOI: 10.1016/s0167-8140(97)00099-6 DOI: https://doi.org/10.1016/S0167-8140(97)00099-6
26. Bey, P.; Wilkinson, P.M.; Resbeut, M.; et al. A double-blind, placebo-controlled trial of i.v. dolasetron mesilate in the prevention of radiotherapy-induced nausea and vomiting in cancer patients. Support. Care Cancer 1996, 4, 378-383. DOI: 10.1007/BF01788845 DOI: https://doi.org/10.1007/BF01788845
27. Franzén, L.; Nyman, J.; Hagberg, H.; et al. A randomised placebo controlled study with ondansetron in patients undergoing fractionated radiotherapy. Ann. Oncol. 1996, 7, 587-592. DOI: 10.1093/oxfordjournals.annonc.a010675 DOI: https://doi.org/10.1093/oxfordjournals.annonc.a010675
28. Lanciano, R.; Sherman, D.M.; Michalski, J.; et al. The efficacy and safety of once-daily Kytril (granisetron hydrochloride) tablets in the prophylaxis of nausea and emesis following fractionated upper abdominal radiotherapy. Cancer Invest. 2001, 19, 763-772. DOI: 10.1081/cnv-100107736 DOI: https://doi.org/10.1081/CNV-100107736
29. Priestman, T.J.; Roberts, J.T.; Upadhyaya, B.K. A prospective randomized double-blind trial comparing ondansetron versus prochlorperazine for the prevention of nausea and vomiting in patients undergoing fractionated radiotherapy. Clin. Oncol. (R. Coll. Radiol.). 1993, 5, 358-363. DOI: 10.1016/s0936-6555(05)80086-x DOI: https://doi.org/10.1016/S0936-6555(05)80086-X
30. Chow, E.; Zeng, L.; Salvo, N.; et al. Update on the systematic review of palliative radiotherapy trials for bone metastases. Clin. Oncol. (R. Coll. Radiol.). 2012, 24, 112-124. DOI: 10.1016/j.clon.2011.11.004 DOI: https://doi.org/10.1016/j.clon.2011.11.004
31. Dennis, K.; Nguyen, J.; Presutti, R.; et al. Prophylaxis of radiotherapy-induced nausea and vomiting in the palliative treatment of bone metastases. Support. Care Cancer 2012, 20, 1673-1678. DOI: 10.1007/s00520-011-1258-x DOI: https://doi.org/10.1007/s00520-011-1258-x
32. Kirkbride, P.; Bezjak, A.; Pater, J.; et al. Dexamethasone for the prophylaxis of radiation-induced emesis: a National Cancer Institute of Canada Clinical Trials Group phase III study. J. Clin. Oncol. 2000, 18, 1960-1966. DOI: 10.1200/JCO.2000.18.9.1960 DOI: https://doi.org/10.1200/JCO.2000.18.9.1960
33. Roila, F.; Herrstedt, J.; Gralla, R.J.; Tonato, M. Prevention of chemotherapy- and radiotherapy-induced nausea and vomiting: guideline update and results of the Perugia consensus conference. Support. Care Cancer 2011, 19, 63-65. DOI: 10.1007/s00520-010-1044-1 DOI: https://doi.org/10.1007/s00520-010-1044-1
34. Molassiotis, A.; Stamataki, Z.; Kontopantelis, E. Development and preliminary validation of a risk prediction model for chemotherapy-related nausea and vomiting. Support. Care Cancer 2013, 21, 2759-2767. DOI: 10.1007/s00520-013-1843-2 DOI: https://doi.org/10.1007/s00520-013-1843-2
35. Pasternak, B.; Svanström, H.; Hviid, A. Ondansetron in Pregnancy and Risk of Adverse Fetal Outcomes. N. Engl. J. Med. 2013, 368, 814-823. DOI: 10.1056/NEJMoa1211035 DOI: https://doi.org/10.1056/NEJMoa1211035
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Copyright (c) 2025 Katarzyna Łysiak, Anna Łysiak, Barbara Maziarz, Paulina Przywara, Natalia Bogumiłło, Kinga Ściurka, Julia Ignacak, Mikołaj Borek, Oliwia Grzelak
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