New generation agents for the prevention of chemotherapy-induced nausea and vomiting

Chemotherapy-induced nausea and vomiting (CINV) is associated with a significant decline in quality of life in cancer patients. The morbidity due to CINV depends on the chemotherapeutic agent, the number of repeated cycles of treatment, and patient characteristics. Discontinuation of chemotherapy due to uncontrolled nausea and vomiting may adversely impact the disease control and patient survival. Significant advances have been made over the last two decades to understand the pathophysiology of CINV. This has led to the development of many newer antiemetics leading to significant improvement in the quality of life in patients receiving emetogenic chemotherapies. Major achievement was made with the introduction of 5-hydroxytryptamine 3 (5-HT3) receptors antagonists, and then more recently neurokinin 1 (NK-1) receptor antagonists. Other effective agents currently available are dopamine receptor antagonists, benzodiazepines, neuroleptics, and cannabinoids. Appropriate utilization of these agents is very effective but a significant proportion of patients still experience CINV. A search for more effective agents is warranted, with an ultimate goal of complete control of CINV.