Chemotherapy-induced nausea nad vomiting — analysis of clinical practice

Abstract

Introduction. Chemotherapy-induced nausea and vomiting (CINV) are common adverse events of antineoplastic treatment. Introduction of the 5-hydroxytryptamine receptor antagonists (a5-HT3) and neurokinin-1 receptor antagonist (aNK1) to clinical practice reduced the acute and delayed CINV. Based on available clinical data, the rate of CINV control in routine practice is unsatisfactory despite the consensus guidelines and recommendations for antiemetic prophylaxis. The purpose of this observational study was to evaluate the pattern of routine antiemetic prophylaxis at oncological units in Poland, where the treatment of patients with highly emetogenic (HEC) cisplatin based che­motherapy at the dose above 70 mg/sqm is performed.

Material and methods. From June to July 2013, 50 oncologist were requested to complete a questionnaire about their opinion on the antiemetic treatment. Additionally, 200 observation cards of patients receiving cisplatin-based chemotherapy at dose more than 70 mg/sqm and routine antiemetic prophylaxis were collected. The frequency of particular drug administration, duration of antiemetic treatment and CINV control rate were analysed.

Results. The main issue of CINV treatment, as reported in 41% of questionnaire, was the lack of efficacy of antiemetic prophylaxis. On day 1, HEC three-drug regimen: aprepitant — aNK1, a5-HT3 and dexamethasone (dex) was administered to 44% patients and combination of a5-HT3 with dex to 40% of patients. On day 2 and 3, aNK1 with dex was administrated to 23% and 26% patients, respectively. 27% of patients received dex in day 4 and 7% — in combination with a5-HT3. An average time of aNK1 treatment was 3 days, of a5-HT3 — 5.8 days and of corticoste­roids — 5.1 days. 80% of patients were advised to take antiemetic drug at home (60% — a5-HT3 and 28% — dex). Complete control of CINV was observed in 46% of patients during acute phase and in 61% patients in delayed phase; 14% of patients developed anticipatory nausea that caused vomiting in 1%. Analysis of visual analogue scale (VAS) revealed that 3-drug regimen lead to the best control of acute and delayed CINV (VAS score 1.48) compared to 2-drug regimen (VAS score 1.83) and monotherapy (VAS score 2.3).

Conclusions. The CINV control rate is increasing when compared to the previous analysis of the population treated with HEC. This observation correlates with the more frequent use of new antiemetic drugs. However, the rate of adherence to antiemetic guidelines remains unsatisfactory. Continued training and monitoring of the supportive treatment quality is required to improve CINV control.