Title
Use of antiemetics in the prevention of chemotherapy-induced nausea and vomiting : review and focus on the Belgian situation Use of antiemetics in the prevention of chemotherapy-induced nausea and vomiting : review and focus on the Belgian situation
Author
Faculty/Department
Faculty of Medicine and Health Sciences
Publication type
article
Publication
Bruxelles ,
Subject
Human medicine
Source (journal)
Acta gastro-enterologica belgica. - Bruxelles, 1946 - 1995
Volume/pages
77(2014) :2 , p. 240-248
ISSN
0001-5644
ISI
000341234800006
Carrier
E
Target language
English (eng)
Affiliation
University of Antwerp
Abstract
Chemotherapy-induced nausea and vomiting (CINV) is a common, distressing, debilitating and costly side effect, experienced by up to 90% of patients receiving highly emetogenic drugs. During the last 20 years great advances have been made in the prevention and treatment of CINV. Aprepitant (a neurokinin-1 antagonist) and palonosetron (a 5-HT3 antagonist) are the most recent additions to the available armamentarium. The aim of this paper is to review the most recent findings concerning the pathophysiology and prevention of CINV, and the international guidelines currently in place for its prevention and treatment. Among the treatments available, 5-HT3 antagonists and NK-1 antagonists are compared. In a large meta-analysis (8 studies in 3 592 patients) statistically significant differences in favour of palonosetron compared with first-generation 5-HT3 antagonists have been demonstrated in the prevention of acute, delayed and overall CINV. A recent, large phase III randomized, gender-stratified, double-blind trial in 848 patients receiving a broad range of moderately emetogenic chemotherapy regimens with a variety of tumour types showed superiority of an aprepitant triple regimen compared to a control regimen of ondansetron and dexamethasone. A new combined 5-HT3/NK-1 treatment, called NEPA (palonosetron/netupitant), has provided very promising preliminary data and is awaited with great anticipation by clinicians. The specific Belgian situation in terms of Health Authorities recommendations and reimbursement policies is also presented. It is concluded that further improvements are still desirable, particularly in the prevention and treatment of delayed emesis.
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