Chemotherapy-Induced Nausea and Vomiting

In the past two decades, significant advances have been made in the management of chemotherapy-induced nausea and vomiting (CINV). These advances are primarily due to a greater understanding of the physiological and molecular pathways underlying CINV, which resulted in major progress in the management of patients with CINV. In the early 1990s, CINV treatment consisted of dex-amethasone [1]. Improvements in the management of CINV control were achieved with the discovery of 5-hydroxytryptamine (5HT 3) receptor and the development of 5HT 3 receptor antagonists (RA). This pathway is primarily involved in the acute phase of CINV. Subsequent studies demonstrated that the usage of the combination of 5HT 3 RA and dexamethasone resulted in additional improvements in CINV control [2, 3]. Over the last decade, the discovery of the neurokinin-1 receptor antagonists (NK 1-RA) and its role in the pathogen-esis of delayed phase of CINV has led to significant developments in the management of this complication of anticancer treatment. More importantly, these milestone achievements are significant and resulted in an improvement in anticancer treatment compliance, as well as an improvement in the quality of life of patients diagnosed with cancer. Despite these achievements, nausea, in particular, and vomiting remain a clinically significant problem for patients receiving both highly emetogenic chemotherapy (HEC) and moderately emetogenic chemotherapy (MEC). Seventy percent of patients treated with cisplatin-based HEC will achieve an overall antiemetic complete response when managed with a triple therapy consisting of a NK 1 RA aprepitant in combination with a 5HT 3 RA and corticosteroids prophylaxis [4, 5]. The current antiemetic guidelines (MASCC/ESMO, ASCO, and NCCN) endorse triple therapy treatment for patients receiving cisplatin-and AC-based chemotherapy regimes [6– 8]. The current special issue includes several reviews including the biology and pharmacology of the NK 1 receptor and substance P, the antiemetic management of germ cell tumor patients undergoing multiple days' chemotherapy treatment, radiotherapy induced nausea and vomiting (RINV), CINV induced by oral cytotoxic agents and targeted therapies in patients undergoing treatment for solid tumors, adherence to CINV guidelines and the benefits of NEPA (a new agent consisting of a combination of netupitant and palonosetron), and the treatment of breakthrough and refractory chemotherapy-induced nausea and vomiting. Additionally, 2 original clinical papers are presented investigating the ramosetron and olan-zapine in the management of CINV. The review article by S. Garcia and P. Gascon provides an extensive overview of the basic knowledge of the NK 1 receptor …