Introduction
Prof. M.S. Aapro, IMO Clinique de Genolier, Genolier, Switzerland
Chemotherapy-induced nausea and vomiting (CINV) continues to be a major concern in cancer treatment. In fact, despite advances in oncological therapies and supportive care, more than 50% of patients undergoing emetogenic chemotherapy still experience acute and delayed CINV1,2. This condition can potentially lead to serious consequences such as dehydration, electrolyte- or pH-imbalances, malnutrition, muscular and neurological events, and even severe organ damage3.
The immediate impact of CINV on Quality of Life (QoL) is obvious. This negative impact has been highlighted by a study in which 70 ovarian cancer patients were asked to rank different effects of chemotherapy, from perfect health to death4: complete control of nausea and vomiting was ranked near perfect health, while severe delayed CINV was ranked close to death. Unfortunately, healthcare providers often underestimate the incidence of CINV in cancer patients and the importance of an effective management of this condition2. In addition, patients report CINV earlier and more frequently than treating physicians do in institutional documentations5. Several Guidelines on the management of CINV have been published by major Scientific Societies such as MASSC/ESMO, ASCO and NCCN6-8, but their adoption in clinical practice remains overall poor9.
The risk of developing CINV depends upon patient- and treatment-related factors6-8,10. Patient-related risk factors include age <50 years, female gender, low chronic alcohol intake, prior episodes of CINV, susceptibility to motion sickness, and anxiety. With respect to treatment-related risk factors, each chemotherapy agent has an intrinsic propensity to cause CINV, the intensity of which depends on the class and dose of drug administered. Current guidelines rank different chemotherapeutics according to the frequency of CINV in patients who are not on any antiemetic prophylaxis: high risk compounds (e.g. cisplatin) are associated with a >90% risk of CINV development; moderate risk compounds (e.g. cyclophosphamide >750 mg/m2 and ≤1,500 mg/m2) with a 30-90% risk; low (docetaxel, etoposide) and minimal (bleomycin, vinblastine) risk agents are associated with a 10-30% and <10% frequency of CINV development, respectively6-8. Other treatment-related factors include different chemotherapy schedules in terms of duration, dose and scheme, and the use of concomitant radiotherapy6-8,10.
All Guidelines agree on the importance of the prevention of CINV, in order to limit the onset of this event and avoid its consequences on patient's physical status and QoL6-8. The choice of the prophylactic agent for the management of CINV should take into consideration all the patient- and treatment-related risk factor presented above.
The "CINV Risk Test", available with this website, is an user-friendly tool which helps the correct evaluation of each patient's relative risk of developing CINV and suggests the optimal treatment for the management of this condition.
References
1. Cohen L, et al. Support Care Cancer 2007; 15: 497-503..
2. Grunberg SM, et al. Cancer 2004; 100: 2261-8.
3. Bender CM, et al. Clin J Oncol Nurs 2002; 6: 94-102.
4. Sun CC, et al. Support Care Cancer 2005; 13: 219-27.
5. Basch E. N Engl J Med 2010; 362: 865-9.
6. MASCC/ESMO Antiemetic Guideline 2011. www.mascc.org.
7. NCCN Clinical Practice Guidelines in Oncology: Antiemesis. Available at www.nccn.org. Last accessed 19th September 2012.
8. Basch E, et al; American Society of Clinical Oncology. J Clin Oncol 2011; 29: 4189-98.
9. Aapro M, et al. Eur J Cancer 2011; 47 (Suppl. 1): S224.
10. Gregory RE, Ettinger DS. Drugs 1998; 55: 173-89.