Volume
10, Issue 2, July - December 2022, Pages 65-79
Original Article
A Systematic Review of the Management of Chemotherapy-Induced Nausea and Vomiting
John Stephen Raj1 , S Monisha2 , MG Rajanandh3 ,K Anandarajagopal4 , S Ponnusankar5
1,2Student, 3Faculty, Department of Pharmacy Practice, Sri Ramachandra Institute of Higher Education and Research, Chennai 600116, Tamil Nadu, India, 4Faculty, Centre of Excellence for Pharmaceutical Sciences, School of Pharmacy, KPJ Healthcare University College, Nilai, Negeri, Malayasia, 5Faculty, Department of Pharmacy Practice, JSS College of Pharmacy, JSS Academy of Higher Education and Research, Ooty, The Nilgiris, Tamil Nadu 643001, India.
Choose an option to locate / access this Article:
90 days Access
Check if you have access
through your login credentials.
PDF
Background: Chemotherapy induced nausea and vomiting is a debilitating effect of the chemotherapy drugs
administered to patients with malignancy and deteriorates the quality of life of the patients. The antiemetic drugs
that are commonly prescribed for controlling CINV are 5-HT3 RA, NK1RA, Dexamethasone, Olanzapine and
Metoclopramide. These drugs are used either in combinations or alone for treating CINV.
Objective: The purpose of this review is to analyze the various treatment modalities for CINV and to identify the
suitable antiemetic agents for nausea and emesis caused by various chemotherapy agents.
Methods: We systematically reviewed randomized controlled trials (RCTs) in adult patients undergoing
chemotherapy treatment and are at risk of CINV, extracting and synthesizing data from eligible articles on study
design, randomization, withdrawal, blinding, type of analysis, duration, and names and doses of drugs. The primary
outcome measure was complete response (no emesis and no administration of rescue medication) in preventing
CINV in acute and delayed phases and secondary outcome was incidence of TRAEs.
Findings: This review included seventeen RCTs among which eleven were blinded and six were open label studies.
Four studies evaluated the effectiveness of olanzapine in preventing CINV in which one of the study compared
efficacy of olanzapine and metoclopramide for the treatment of breakthrough emesis. One of the study compared
the efficacy of granisetron as transdermal delivery system with ondansetron in preventing CINV and concluded that
granisetron transdermal system was non inferior to ondansetron in controlling CINV. Three studies investigated the
change in the prevention of CINV on single day administration of dexamethasone with multiple day administration
of dexamethasone. All the three studies reported that single day administration of dexamethasone was similar
in efficacy to multiple day dosing. Two studies investigated the efficacy of rolapitant in which one of the study
concluded that addition of rolapitant to antiemetic treatment regimen consisting of granisetron and dexamethasone
significantly improved CINV compared with treatment regimen without rolapitant. Three studies evaluated the
efficacy of NEPA which is a combination of Netupitant (NK1 RA) and Palonosetron (5HT3 RA)among which one
study concluded that NEPA was superior to Palonosetron and in another NEPA was compared with palonosetron
and aprepitant and concluded that NEPA was similar to them in controlling CINV. One study evaluated the efficacy
of fosaprepitant, a prodrug of aprepitant compared to aprepitant and concluded that single dose fosaprepitant was
non inferior to multiple day administration of aprepitant. Two studies evaluated fosnetupitant in which one study
compared the efficacy of fosnetupitant at the dose of 81 mg and 235 mg and concluded that dose of 235 mg was
superior to 81 mg of fosnetupitant. The other study compared the safety profile of fosnetupitant to fosaprepitant
How to cite this article:
John Stephen Raj, S Monisha, MG Rajanandh, et. al./ A Systematic Review of the Management of Chemotherapy-Induced Nausea
and Vomiting/Indian J Canc Educ Res 2022;10(2):65-79.
and concluded that both were similar.
Conclusion: Antiemetic triplet treatment
regimen for CINV consisting of 5HT3 RA, NK1 RA
and dexamethasone was found to be effective in
this review but the quality of some of the evidence
of the studies included in this review contains high
risk of bias and is not completely reliable. Hence
we recommend that future trials be conducted
with minimum risk of bias to ensure high quality
of evidence.