updated in 2019 6 and report
that netupitant and rolapitant
are effective antiemetics in the
prevention of delayed nausea and
palonosetron and granisetron
extended-release injection
formulation as preferred 5-HT 3 RAs
for delayed nausea prevention in
the MEC setting.
For breakthrough emesis
prevention, switch to a different
NK 1 RA with a different PK/PD
profile is recommended. Although
no clinical trial data are available,
anectdotal evidence suggests this
might be useful.
Nausea, by contrast, is more
difficult to control. Among
patients receiving emetogenic
chemotherapy and treated
effectively with anti-emetics,
nausea is often seen more
frequently than vomiting.
Generally, nausea is more likely
to be seen in younger patients
than older patients, and younger
women being treated for breast
cancer are more prone to nausea
than other groups of patients.
Delayed nausea happens more
often than acute nausea and
is more severe and tends to be
treatment resistant. Therefore
prevention of nausea is a high
priority in clinical research. 5,7
Poorly controlled CINV can also
lead to interruptions in treatment
or discontinuation of therapy as
a result of poor compliance. 12
CINV can result in fatigue,
anorexia, insomnia, dehydration,
electrolyte imbalance, weakness
and weight loss. 13
Health-related QoL
CINV has a significant negative
impact on health-related QoL,
even when antiemetic therapy
is used after HEC or MEC. 14
Bloechl-Daum et al studied the
effect of CINV on the QoL in
298 patients with cancer – 67 of
whom were treated with HEC
and 231 with MEC. Overall, on
day 6 after chemotherapy, 61% of
patients reported that CINV had
no or minimal impact on daily
life (NIDL), with significantly
fewer HEC patients reporting
NIDL than those receiving MEC
(47.2% versus 64.5% respectively;
p=0.0272). Nausea seemed to have
a greater impact on daily life than
vomiting as indicated by the mean
Functional Living Index-Emesis
(FLIE; a validated nausea- and
vomiting-specific patient-reported
outcome measure): the nausea
domain score for all patients was
50.0 (44.7 for HEC and 51.4 for
MEC; p=0.0024), compared with
a mean FLIE vomiting domain
score of 55.3 (50.3 for HEC and 56.5
for MEC; p=0.0097). The authors
noted that this was also reflected
by the NIDL data, with 53.1% of
patients reporting NIDL for nausea
compared with 73.4% with NIDL
for vomiting. CINV associated
with HEC has a significantly
lower mean FLIE score compared
with MEC (95.5 vs 107.8,
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