Summary
Nausea and vomiting continue to be critical problems in cancer chemotherapy, although considerable progress has been made toward understanding the neuropharmacological mechanisms of vomiting and how chemotherapeutic agents and antiemetics affect these mechanisms. The principles of behavioural psychology have also been applied in an effort to understand and effectively manage these complications which have potentially serious consequences. For example, there is now some degree of rationality to our use of metoclopramide for cisplatin-induced nausea and vomiting, the use of combination antiemetic regimens, and use of lorazepam for the prevention (albeit unproven) of anticipatory nausea and vomiting. It must be admitted, however, that our approach is for the most part still empirical
Selecting an antiemetic programme is not a simple task. The emetogenic potential of the chemotherapy being used, the presence of coexisting diseases, the potential toxicity of the antiemetic drug and whether antiemetic therapy is to take place in the hospital or in an outpatient setting, the familiarity of the clinician with the various antiemetic therapies, and cost are all factors which need to be considered. Although phenothiazines remain the standard treatment, they are of little value against chemotherapy programmes that produce moderate or severe problems. Newer pharmacological approaches including butyrophenones, cannabinoids, metoclopramide, high-dose corticosteroids, and benzodiazepines have shown increased antiemetic efficacy, as have combinations of these agents which are directed against multiple sites of emetogenic activity. The role of behavioural therapies, which have been shown to be effective particularly in children and in anticipatory nausea and vomiting, needs to be more firmly established.
Rather than recommending a given antiemetic programme for any particular chemotherapy, it is preferable to think in terms of initial approaches and how they can be modified. No one antiemetic programme is effective or safe in all situations.
Similar content being viewed by others
References
Akwari OE. The gastrointestinal tract in chemotherapy-induced emesis: a final common pathway. Drugs 25(Suppl. 1): 18–34, 1983
Altmaier EM, Ross WE, Moore K. A pilot investigation of the psychologic functioning of patients with anticipatory vomiting. Cancer 49: 201–204, 1982
Artim R, DiBella N. Tetrahydrocannabinol plus prochlorperazine for refractory nausea and vomiting. Abstract. Proceedings of the American Society of Clinical Oncologists 2: 85, 1983
Borison HC, McCarthy LE. Neuropharmacologic mechanisms of emesis. In Laszlo (Ed.) Antiemetics and cancer chemotherapy, pp. 6–20, Williams & Wilkins, Baltimore, 1983
Bruera ED, Roca E, Cedaro L, et al. Improved control of chemotherapy-induced emesis by addition of dexamethasone to metoclopramide in patients resistant to metoclopramide. Cancer Treatment Reports 67: 381–383, 1983
Cassileth PA, Lusk EJ, Torri S, et al. Antiemetic efficacy of dexamethasone therapy in patients receiving cancer chemotherapy. Archives of Internal Medicine 143: 1347–1349, 1983
Chang AE, Shiling DJ, Stillman RC, et al. Delta-9-tetrahydro-cannabinol as an antiemetic in patients receiving high dose methotrexate: a prospective randomized evaluation. Annals of Internal Medicine 91: 81–82, 1979
Fortner CL, Finley RS, Grove WR. Combination antiemetic therapy in the control of chemotherapy-induced emesis. Drug Intelligence and Clinical Pharmacy 19: 21–24, 1985
Gralla RJ, Itri LM, Pisko SE, et al. Antiemetic efficacy of high-dose metoclopramide: randomized trials with placebo and prochlorperazine in patients with chemotherapy-induced nausea and vomiting. New England Journal of Medicine 305: 905–909, 1981
Hrushesky WJM. The clinical applications of chronobiology to oncology. American Journal of Anatomy 168: 519–542, 1983
Jordan NS, Schauer PK, Schauer A, Nightingale C, Golub G, et al. The effect of administration rate on cisplatin-induced emesis. Journal of Clinical Oncology 3: 559–561, 1985
Laszlo J, Clark RA, Hanson DC, Tyson L, Crumpler L, et al. Lorazepam in cancer patients treated with cisplatin: a drug having antiemetic, amnesic, and anxiolytic effects. Journal of Clinical Oncology 3: 864–869, 1985
Lee BJ. Methylprednisolone as an antiemetic. New England Journal of Medicine 304: 486, 1981
Lucas VS. Phenothiazines as antiemetics. In Laszlo (Ed.) Antiemetics and cancer chemotherapy, pp. 93–107, Williams & Wilkins, Baltimore, 1983
Maher J. Intravenous lorazepam to prevent nausea and vomiting associated with cancer chemotherapy. Lancet 1: 91–92, 1981
Mellink WT, Blijham GH, Van Deyk WH. Amitriptyline plus fluphenazine to prevent chemotherapy-induced emesis in cancer patients: a double-blind randomized cross-over study. European Journal of Cancer and Clinical Oncology 20: 1147–1150, 1984
Meyer BR, Leurin M, Drayer DE, et al. Optimizing metoclopramide control of cisplatin-induced emesis. Annals of Internal Medicine 100: 393–395, 1984
Morran C, Smith DC, Anderson DA, McArdle CS. Incidence of nausea and vomiting with cytotoxic chemotherapy: a prospective randomized trial of antiemetics. British Medical Journal 1: 1323–1324, 1979
Morrow GR. Prevalence and correlates of anticipatory nausea and vomiting in chemotherapy patients. Journal of the National Cancer Institute 68: 585–588, 1982
Morrow GR, Morrell C. Behavioral treatment for the anticipatory nausea and vomiting induced by chemotherapy. New England Journal of Medicine 307: 1476–1480, 1982
Peroutka SJ, Snyder SH. Antiemetics: neurotransmitter receptor binding predicts action. Lancet 1: 658–659, 1982
Plezia PM, Alberts DS, Aapro MS, et al. Immediate termination of intractable cisplatin induced vomiting with an intensive 5-drug antiemetic regimen. Abstract. Proceedings of the American Society of Clinical Oncologists 2: 93, 1983
Plotkin DA, Plotkin D, Okun R. Haloperidol in the treatment of nausea and vomiting due to cytotoxic drug administration. Current Therapeutic Research 15: 599–602, 1973
Redd WH, Andresen GV. Conditioned aversion in cancer patients. Behaviour Research and Therapy 4: 3–4, 1981
Robins HI, Erschler WB, DeJongh L, et al. Antiemetic effect of intravenous lorazepam in patients receiving cis-diamine choroplatinum II: a pilot study. Medical and Pediatric Oncology 7: 247–249, 1979
Sallan SE, Cronin CM. Nausea and vomiting. In DeVita VT, et al. (Eds) Cancer: principles and practice, pp. 2008–2013, Lippincott, Philadelphia, 1985
Sawicka J, Sallan SE. Transdermal therapeutic system scopolamine: prevention of vomiting associated with cancer chemotherapy. Abstract. Proceedings of the American Society of Clinical Oncologists 18: 302, 1977
Seigel LJ, Longo DL. The control of chemotherapy-induced emesis. Annals of Internal Medicine 95: 352–359, 1981
Stoudemire A, Cotanch P, Laszlo J. Recent advances in the pharmacologic and behavioral management of chemotherapy-induced emesis. Archives of Internal Medicine 144: 1029–1033, 1984
Strum SB, McDermed JE, Liponi DF. High-dose intravenous metoclopramide versus combination high-dose metoclopramide and intravenous dexamethasone in preventing cisplatininduced nausea and emesis: a single-blind crossover comparison of antiemetic efficacy. Journal of Clinical Oncology 3: 245–251, 1985
Vincent BJ, McQuiston DJ, Einhorn LH, Nagy CM, Brames MJ. Review of cannabinoids and their antiemetic effectiveness. Drugs 25(Suppl. 1): 52–62, 1983
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Triozzi, P.L., Laszlo, J. Optimum Management of Nausea and Vomiting in Cancer Chemotherapy. Drugs 34, 136–149 (1987). https://doi.org/10.2165/00003495-198734010-00005
Published:
Issue Date:
DOI: https://doi.org/10.2165/00003495-198734010-00005