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Nausea and Vomiting

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The MASCC Textbook of Cancer Supportive Care and Survivorship

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Abstract

The introduction of two new classes of antiemetics, the 5-hydroxytryptamine-3 receptor antagonists (5-HT3-RAs) and the neurokinin 1 receptor antagonists (NK1-RAs), has revolutionised the treatment of post-chemotherapy acute and delayed nausea and vomiting, and this in turn has decreased the incidence of anticipatory emesis. Triple antiemetic therapy combining a 5-HT3-RA and NK1-RA with dexamethasone is recommended by MASCC/ESMO for the prevention of nausea and vomiting, associated with chemotherapy of high emetic potential including the anthracycline/cyclophosphamide (AC) regimen and carboplatin-based chemotherapy. Nausea is not as well controlled as vomiting but is a symptom that has multiple associated symptoms to treat. There are few differences between 5-HT3-RAs, except palonosetron with a longer half-life and better control of delayed emesis. Single agents are recommended for the prevention of emesis in patients receiving chemotherapy of low emetic potential and who have a prior history of emesis, while no antiemetic prevention is recommended prior to chemotherapy of minimal emetic potential. Olanzapine as the preferred option or less effective older antiemetics such as dopamine antagonists and adjuvant drugs such as the benzodiazepines can be used for emesis that is refractory to the above antiemetic regimens. More research is needed into the optimal antiemetic regimens for children receiving chemotherapy, patients receiving high-dose chemotherapy, and those being treated with radiotherapy.

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Authors and Affiliations

  1. Internal Medicine V, Hematology, Oncology, Rheumatology, University Hospital Heidelberg, Heidelberg, Baden-Württemberg, Germany

    Karin Jordan

  2. Cancer Research Institute, University of South Australia, Adelaide, SA, Australia

    Ian Olver

  3. Cancer Center, Institut Multidisciplinaire d’Oncologie, Clinique de Genolier, Genolier, Vaus, Switzerland

    Matti Aapro

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    Ian Olver

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Jordan, K., Olver, I., Aapro, M. (2018). Nausea and Vomiting. In: Olver, I. (eds) The MASCC Textbook of Cancer Supportive Care and Survivorship. Springer, Cham. https://doi.org/10.1007/978-3-319-90990-5_26

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  • DOI: https://doi.org/10.1007/978-3-319-90990-5_26

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-90989-9

  • Online ISBN: 978-3-319-90990-5

  • eBook Packages: MedicineMedicine (R0)

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