Better Drugs, Improved Adherence Key to Managing Chemotherapy-Induced Nausea

Aminah Jatoi, MD, professor of oncology at the Mayo Clinic, outlined strategies for preventing and managing nausea and vomiting caused by chemotherapy treatment during a presentation at the NAMCP Spring Managed Care Forum 2017. Her presentation, entitled “Understanding Appropriate Treatments to Prevent and Manage Chemotherapy-Induced Nausea and Vomiting,” was given as part of the conference’s oncology management track.

She began by discussing the clinical and biological basics of chemotherapy induced nausea and vomiting. Dr Jatoi explained that the risk of nausea and vomiting as an adverse reaction are high when treating with cisplatin, moderate when treating with oxaliplatin or ifosfamide, low with paclitaxel or 5‐fluorouracil, and very low with vincristine or bleomycin. She further explained that nausea and vomiting within 24 hours of treatment is known as acute, while anything after 24 hours is considered delayed.

Dr Jatoi then discussed how to best manage nausea and vomiting in patients using data from randomized, controlled trials. She explained that based on evidence, for chemotherapy with high toxicity, the best treatments are a 5‐HT3 receptor antagonist, an NK1R antagonist, and dexamethasone. Otherwise, for patients treated with chemotherapy with a low emetogenic risk, a single 8 mg dose of dexamethasone provides adequate control.

Dr Jatoi also explained that anticipatory vomiting—episodes that occur within 12 hours of treatment—is best prevented by controlling nausea and using benzodiazepines.

She emphasized that further drug development in this area is needed to better control nausea and vomiting related to chemotherapy. She noted that a new drug, olanzapine, may be added to the standard of care for treating chemotherapy-induced vomiting and nausea, based on recent clinical trial data.

“Antiemetic combinations are effective in 80% of patients if used appropriately,” she concluded. “The 80% ceiling effect can be improved upon by better drugs but also, importantly, by better guideline adherence.”