From the Guidelines
The most effective anti-emetic regimen for cancer patients includes a combination of palonosetron and dexamethasone, with the option to add aprepitant for enhanced prevention of nausea and vomiting. This recommendation is based on the most recent and highest quality evidence available, specifically the 2016 American Society of Clinical Oncology focused guideline update 1. The guideline suggests that the oral combination of netupitant and palonosetron can be used for the prevention of acute and delayed nausea and vomiting in patients receiving chemotherapy.
Key Medications
- 5-HT3 receptor antagonists: palonosetron, granisetron, and ondansetron
- NK1 receptor antagonists: aprepitant
- Corticosteroids: dexamethasone
Recommended Regimen
The recommended regimen includes palonosetron (day 1 only) and dexamethasone (days 1 through 3) for patients receiving moderately emetogenic chemotherapy, as stated in the 2011 American Society of Clinical Oncology clinical practice guideline update 1. If palonosetron is not available, clinicians may substitute a first-generation 5-HT3 receptor antagonist, preferably granisetron or ondansetron. Additionally, limited evidence supports adding aprepitant to the combination for enhanced prevention of nausea and vomiting.
Breakthrough Nausea Management
For breakthrough nausea, medications like metoclopramide, prochlorperazine, or olanzapine can be effective, as they work by blocking different pathways that trigger nausea. However, the primary focus should be on preventing nausea and vomiting through the use of the recommended anti-emetic regimen.
Importance of Regular Schedule and Hydration
Taking anti-nausea medications on a regular schedule rather than as needed provides better symptom control, and patients should stay well-hydrated and eat small, frequent meals to help manage nausea, as supported by the 2011 American Society of Clinical Oncology clinical practice guideline update 1.
From the FDA Drug Label
Aprepitant capsules, in combination with other antiemetic agents, are indicated in patients 12 years of age and older for the prevention of: • acute and delayed nausea and vomiting associated with initial and repeat courses of highly emetogenic cancer chemotherapy (HEC) including high-dose cisplatin • nausea and vomiting associated with initial and repeat courses of moderately emetogenic cancer chemotherapy (MEC)
The anti-emetic medications for cancer include:
- Aprepitant: a substance P/neurokinin 1 (NK1) receptor antagonist
- Dexamethasone: a corticosteroid
- 5-HT3 antagonist: the specific medication is not specified in the label, but it is recommended to be used in combination with aprepitant and dexamethasone for the prevention of nausea and vomiting associated with highly emetogenic cancer chemotherapy (HEC) and moderately emetogenic cancer chemotherapy (MEC) 2 2 2
From the Research
Anti-emetic Medications for Cancer
- The following medications are used to prevent nausea and vomiting associated with cancer treatment:
- These medications have been shown to be effective in preventing chemotherapy-induced nausea and vomiting (CINV) 3, 4, 5, 6, 7
Comparison of Anti-emetic Medications
- Studies have compared the efficacy of ondansetron and granisetron, with results showing equal antiemetic efficacy in reducing or eliminating CINV 7
- Palonosetron has been shown to be effective in preventing CINV when used in combination with aprepitant and dexamethasone 6
- The choice of anti-emetic medication may depend on factors such as the type of chemotherapy, the patient's medical history, and the potential side effects of the medication 3, 5
Side Effects and Safety
- The side effects of anti-emetic medications are generally mild and temporary, but may include constipation, headache, and dizziness 6, 7
- The safety of these medications has been evaluated in numerous studies, with results showing that they are well-tolerated and effective in preventing CINV 3, 4, 5, 6, 7