validation of major predisposing
characteristics, either patient-
related or treatment-specific
factors, can lead to the
development of digital tools
providing information in real-time
that can be easily implemented
into the patients’ treatment plans.
This would contribute to a better
use of existing antiemetics and a
reduction in the frequency and
severity of CINV.
Incidence and types of CINV
Acute nausea and vomiting
symptoms manifest within the
first 24 hours after a cycle of
chemotherapy session and are
mainly the result of the release
of serotonin from cells in the
intestinal mucosa, which then
binds to receptors on vagal afferent
nerves in the intestine, triggering
the vomiting reflex. In contrast,
delayed nausea and vomiting
events usually develop between 25
and 120 hours after chemotherapy
administration and respond less
well to the common antiemetic
serotonin receptor antagonists
(RAs) used in the acute phase,
being managed predominantly
with neurokinin-1 (NK1) RAs. 1
A pooled analysis of data from
more than 1000 patients with solid
tumours or lymphoma enrolled
in prospective studies of CINV
demonstrated that acute nausea
and vomiting were reported in
approximately 23% and 47% of
treatment cycles, respectively,
26 | 2018 | hospitalpharmacyeurope.com
whereas delayed nausea and
vomiting events were seen in 25%
and 68% of the chemotherapy
cycles. The overall proportion of
cycles for which CINV symptoms
were reported was 61%, and 42%
of those cycles involved CINV
with a Grade 2 severity or higher.
It was also observed that CINV
tended to affect patients mostly at
early stages of treatment. In fact,
approximately half (52%) of the
patients undergoing chemotherapy
experienced CINV after cycle 1,
followed by 44% after cycle 2,
and approximately 40% after
cycles 2–5. After cycle 6, the
proportion affected by CINV
dropped to about one-third of
the patients. 2
Clinicians often underestimate
the incidence of delayed CINV,
although poor antiemetic control
in cycle 1 of chemotherapy is
known to be a strong predictor
of development of symptoms at
later cycles. Delayed CINV occurs
more frequently when cytotoxic
agents such as cyclophosphamide
and doxorubicin and platinum-
based agents are used, but type
of chemotherapy regimen was
revealed to be an inconsistent
predictor of late-phase CINV.
Nonetheless, the general
classifications by the different
professional societies of the
potential for emetogenicity for
chemotherapy agents administered
intravenously is mostly based
on the incidence of acute CINV,