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Antiemetics: an update and the MASCC guidelines applied in clinical practice

Nature Clinical Practice Oncology volume 5, pages 32–43 (2008)Cite this article

Abstract

Nausea and vomiting are two of the most severe problems for patients treated with chemotherapy. Until the late 1970s, nausea and vomiting induced by chemotherapy was an almost neglected research area. With the introduction of cisplatin, the cytotoxin with the highest emetic potential, research was stimulated and has now resulted in the development of two new classes of antiemetics, the serotonin and neurokinin antagonists. A large number of trials have fine-tuned antiemetic therapy and made evidence-based recommendations possible for the majority of patients receiving chemotherapy. This Review discusses the pathophysiology of nausea and vomiting, the development of antiemetics, highlights some of the newest antiemetics, and finally summarizes recommendations from the evidence-based guidelines developed by the Multinational Association of Supportive Care in Cancer.

Key Points

  • Although the pathophysiology of nausea and vomiting is still not completely elucidated, the increased understanding of the basic mechanisms has advanced the clinical development of antiemetics

  • Corticosteroids are useful antiemetics; recently, the development of serotonin antagonists and the neurokinin antagonist, aprepitant, have resulted in a significant decrease in the number of vomiting episodes experienced by patients receiving emetogenic chemotherapy

  • Treatment of the nausea associated with emetogenic chemotherapy is still a major problem

  • Evidence-based guidelines for antiemetic treatment have been developed and are updated on a regular basis; implementation of these guidelines should be encouraged

  • Promising results from phase II studies, of dexamethasone plus different two-drug combinations of the new serotonin antagonist, palonosetron, the neurokinin antagonist, aprepitant, and the antipsychotic agent, olanzapine, require verification in large randomized trials

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  1. J Herrstedt is Chief Physician at the Department of Oncology, Copenhagen University Hospital, Herlev, Denmark.,

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The author is a Consultant for GlaxoSmithKline, Helsinn, Merck and Schering—Plough, and is on the Speakers bureau for Merck. He also receives research/grant support from GlaxoSmithKline and Merck.

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Herrstedt, J. Antiemetics: an update and the MASCC guidelines applied in clinical practice. Nat Rev Clin Oncol 5, 32–43 (2008). https://doi.org/10.1038/ncponc1021

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