Options for the treatment of chemotherapy-induced nausea and vomiting (CINV) include 5-HT3 receptor antagonists and NK-1 receptor antagonists, says Charles L. Loprinzi, MD. Palonosetron has a higher binding efficiency and longer half-life than the other 5-HT3 receptor antagonists ondansetron, granisetron, and dolasetron.
Aprepitant, an oral agent given over 3 days, was the first NK-1 receptor antagonist to become available in the United States. Fosaprepitant is an IV formulation that is given on the first day of chemotherapy. The administration of fosaprepitant is associated with venous toxicities, limiting its use, says Loprinski. The newest NK-1 receptor antagonist to gain FDA approval is rolapitant, which is an oral formulation given on day 1 of chemotherapy.
More recently, a combination drug has become available for the treatment of CINV called NEPA, which is an oral formulation containing the 5-HT3 receptor antagonist netupitant and the NK-1 receptor antagonist palonosetron.
Corticosteroids are also used in the treatment of CINV. They are used mostly in patients who are receiving low or moderately emetogenic chemotherapy, states Eric Roeland, MD. Steroids can be given on subsequent days of chemotherapy, such as days 2 through 4. Due to the side effects, glucocorticoids are not for long-term use, adds Roeland.
Benzodiazepines have a unique role in treating anticipatory nausea, states Roeland. Of the available agents in this class, lorazepam is one of the safest, given its half-life and metabolic profile, he adds.
Other classes of drugs used to treat CINV include dopamine antagonists, such as haloperidol and olanzapine, and cannabinoids.