antiemetic prophylaxis to cover
the entire risk period, both acute
and delayed, thus also reducing
the incidence of anticipatory,
breakthrough and refractory
CINV.
Categories of emetogenicity
A useful framework for classifying
the emetic potential of cancer
chemotherapy agents was
developed in 1997 by Hesketh and
colleagues. 9 This was modified
in 2004 at an expert consensus
congress, 10 and it usefully divides
chemotherapy agents into
four levels, depending on their
emetogenicity: high, moderate,
low, and minimal (see Table 3).
This framework has become
an accepted standard for defining
emetogenicity with internationally
recognised bodies such as the
American Society of Clinical
Oncology, the Multinational
Association of Supportive Cancer
Care (MASCC), ESMO and NCCN
being among those that use it as
the basis for the development of
antiemetic guidelines. 11–13
Conclusions
Nausea and vomiting associated
with chemotherapy is multifaceted
and multifactorial. Understanding
the complexity of these factors and
the underlying pathophysiology
will better enable healthcare
professionals to provide
appropriate interventions to
reduce symptoms.
12 | 2019 | hospitalpharmacyeurope.com
References
1 Carelle N et al. Changing patient perceptions
of the side effects of cancer chemotherapy.
Cancer 2002;95(1):155–63.
2 Grunberg SM et al. Incidence of
chemotherapy-induced nausea and emesis
after modern antiemetics. Cancer
2004;100(10):2261–8.
3 Navari RM, Aapro M. Antiemetic prophylaxis
for chemotherapy-induced nausea and vomiting.
N Engl J Med 2016;374:1356–67.
4 Miller AD, Wilson VJ. Vomiting Centre
reanalyzed: an electrical stimulation study.
Brain Res 1983;270:154–8.
5 Baker D, Morzorati S, Ellet M. The
pathophysiology of chemotherapy induced
nausea and vomiting. Gastroenterol Nurs
2005;28:469–80.
6 Jordan K, Schmoll HJ, Aapro MS. Comparative
activity of antiemetic drugs. Crit Rev Oncol
Hematol 2007;61:162–175.
7 Roila F et al. Delayed emesis: incidence,
pattern, prognostic factors and optimal
treatment. Support Care Cancer 2002;10:88–95.
8 Aapro MS, Molassiotis A, Olver I. Anticipatory
nausea and vomiting. Support Care Cancer
2005;13:117–21.
9 Hesketh PJ et al. Proposal for classifying the
acute emetogenicity of cancer chemotherapy.
J Clin Oncol 1997;15:103–9.
10 Roila F et al. Prevention of chemotherapy-
and radiotherapy-induced emesis: results
of the 2004 Perugia International Antiemetic
Consensus Conference. Ann Oncol 2006;17:
20–8.
11 Roila F et al. MASCC and ESMO Consensus
Guidelines for the Prevention of Chemotherapy
and Radiotherapy-Induced Nausea and
Vomiting: ESMO Clinical Practice Guidelines.
Ann Oncol 2016;27(suppl 5):v119–v133.
12 NCCN. NCCN Clinical Practice Guidelines in
Oncology; Version 1.0 2019. www.nccn.org.
13 Hesketh PJ et al. Antiemetics: American
Society of Clinical Oncology clinical practice
guideline update. J Clin Oncol 2017;35:3240–61.