HPE CINV Pocket Guide 2018 | Page 22

table 2 Summary of the process of developing guideline recommendations (continuation) • Anticipatory emesis • Radiotherapy-induced emesis • Radiotherapy and chemotherapy combination NCCN (National Comprehensive Cancer Network) • Covers IV and oral chemotherapy • Classification of emesis • Prevention of acute emesis for high and moderate emetic chemotherapy • Prevention of delayed emesis for high and moderate emetic chemotherapy • Prevention of emesis for minimal and low emetic chemotherapy • Oral chemotherapy • Breakthrough treatment • Anticipatory emesis • Rescue antiemetic therapy • Radiotherapy-induced emesis MASCC/ESMO have further added new guidelines for managing nausea/vomiting in advanced cancer and NCCN provided in the latest update guidelines for CINV related to oral chemotherapy drugs. All guidelines have had updated recommendations for preventing CINV in children, high-dose chemotherapy, multiple- day chemotherapy and for breakthrough CINV. We now better (but not completely) understand the pathophysiology of CINV. This 22 | 2018 | hospitalpharmacyeurope.com has led to the identification of newer pathways implicated in the development of nausea and vomiting, including the NK1 receptors, alongside the serotonin 5-HT3 receptors and dopamine receptors, among others. The introduction of 5-HT3 RAs in the management of CINV in the early 1990s has significantly improved these symptom outcomes for patients. Second-generation 5-HT3 RAs (that is, palonosetron) have been introduced to the market in the past decade. The field of