Chemotherapy and cancer related nausea and vomiting

[摘要] Approximately one half of patients will experience nausea or vomiting during the course of their disease either due to the cancer itself or treatment. Emesis due to cancer warrants a careful investigation to determine whether or not there is a treatable underlying cause.Dexamethasone and octreotide are interventions that may reduce vomiting due to bowel obstruction. In the absence of a bowel obstruction or a correctable cause, the usual approach is a sequential trial of antiemetics guided by considerations of cost and side effects.Major progress in managing chemotherapy induced emesis followed the use of a combination of a corticosteroid plus 5-hydroxytryptymine3 (5-HT3) receptor antagonist for moderately to highly emetogenic chemotherapy. Nevertheless, vomiting still occurred in approximately 40% of women receiving chemotherapy containing an anthracycline plus cyclophosphamide and 50% of patients receiving high dose cisplatin. The addition of aprepitant, a neurokinin1 (NK1) receptor antagonist, improved control of emesis by a further 15-20% and is now recommended as part of standard antiemetic therapy for patients at high risk of emesis. Cannabinoids and olanzapine are sometimes also recommended in patients with refractory emesis based upon largely anecdotal experience. Phase III trials are required to confirm their efficacy as add-ons to a corticosteroid, a 5-HT3 receptor antagonist and possibly aprepitant.

[学科分类] 肿瘤学