table 2
Summary of the process of developing guideline
recommendations (continuation)
• Anticipatory emesis
• Radiotherapy-induced emesis
• Radiotherapy and chemotherapy
combination
NCCN (National Comprehensive
Cancer Network)
• Covers IV and oral chemotherapy
• Classification of emesis
• Prevention of acute emesis for high
and moderate emetic chemotherapy
• Prevention of delayed emesis
for high and moderate emetic
chemotherapy
• Prevention of emesis for minimal
and low emetic chemotherapy
• Oral chemotherapy
• Breakthrough treatment
• Anticipatory emesis
• Rescue antiemetic therapy
• Radiotherapy-induced emesis
MASCC/ESMO have further added
new guidelines for managing
nausea/vomiting in advanced
cancer and NCCN provided in the
latest update guidelines for CINV
related to oral chemotherapy
drugs. All guidelines have had
updated recommendations for
preventing CINV in children,
high-dose chemotherapy, multiple-
day chemotherapy and for
breakthrough CINV.
We now better (but not
completely) understand the
pathophysiology of CINV. This
22 | 2018 | hospitalpharmacyeurope.com
has led to the identification of
newer pathways implicated in
the development of nausea and
vomiting, including the NK1
receptors, alongside the serotonin
5-HT3 receptors and dopamine
receptors, among others. The
introduction of 5-HT3 RAs in the
management of CINV in the early
1990s has significantly improved
these symptom outcomes for
patients. Second-generation 5-HT3
RAs (that is, palonosetron) have
been introduced to the market
in the past decade. The field of