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.