Development of Antiemetic Therapy in Cancer Patients

Abstract

Patients still consider nausea and vomiting to be severe adverse consequences of cancer chemotherapy. The physiology of chemotherapy-induced nausea is generally unknown, but the finding that high doses of metoclopramide induce the antiemetic effect by antagonizing 5-HT₃ receptors, has evoked increased interest in serotonin as a possible neurotransmitter. This has led to development of more selective 5-HT₃ antagonists, such as ondansetron, granisetron and tropisetron, with improvement of antiemetic therapy, especially in patients receiving cisplatin-based chemotherapy. The efficacy of serotonin antagonists is further optimized by the addition of steroids and the dopamine D₂ antagonist metopimazine. Many questions in antiemetic treatment are still unanswered and future trials should focus on patients receiving multiple-day chemotherapy or multiple cycles of chemotherapy and on patients resistant to initial antiemetic therapy.