New treatments on the horizon for chemoradiotherapy-induced nausea and vomiting

ABSTRACT

Introduction: Antiemetic prophylaxis for the prevention of chemotherapy-induced nausea and vomiting, and the development of new antiemetic drugs are expanding areas of research. However, studies of antiemetic prophylaxis in chemoradiotherapy have not been prioritised, and little is known about the proper timing, duration, and combination of antiemetic drugs for the prevention of chemoradiotherapy-induced nausea and vomiting (C-RINV).

Areas covered: The article summarises the available antiemetic studies, the evidence for antiemetic prophylaxis of C-RINV, and the future perspectives for antiemetic research in chemoradiotherapy.

Expert opinion: Antiemetic prophylaxis for patients receiving concomitant chemoradiotherapy has, for many years, been an orphan research area. The distinction between acute and delayed nausea and vomiting does not apply to fractionated radiotherapy, and prophylaxis should be considered to cover the entire course of treatment and not only the acute and delayed chemotherapy-induced nausea and vomiting. The best prophylaxis in women receiving fractionated radiotherapy and concomitant weekly cisplatin is a combination of the neurokinin receptor antagonist fosaprepitant with palonosetron and dexamethasone. Even with this three-drug combination nausea is a significant problem and the effect of multi-receptor targeting antiemetics such as olanzapine and amisulpride should be explored in this setting.

KEYWORDS:

• Antiemetic prophylaxis
• concomitant chemotherapy
• fosaprepitant
• nausea
• radiotherapy
• vomiting

Article highlights

• Nausea and vomiting are frequently experienced in patients receiving chemoradiotherapy.

• Few studies have addressed chemoradiotherapy-induced nausea and vomiting (C-RINV).

• The evidence for the guidelines recommendations for antiemetic prophylaxis in chemoradiotherapy is sparse.

• There is emerging evidence that the NK₁ receptor antagonists improve the control of C-RINV in certain treatment settings.

• The NK₁ receptor antagonists should be explored for efficacy and safety during the various concomitant chemoradiotherapy settings of high – moderate emetic risk.

• Multi-receptor targeting antiemetics (e.g. olanzapine) should be explored to improve prevention of nausea in this setting.

This box summarizes key points contained in the article.

Declaration of interest

J Herrstedt declared to be a member of the rolapitant advisory board, Tesaro. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.