Nausea and/or vomiting are frequent side effects of chemotherapy and radiation therapy. While these used to be among the most debilitating side effects of chemotherapy, the development of new and more effective antiemetic (anti-vomiting) drugs has provided relief and many patients no longer experience nausea or vomiting at all.
Nausea is feeling queasy or sick to your stomach, like you’re going to throw up. Vomiting is emptying your stomach by throwing up. Nausea and/or vomiting are frequent side effects of chemotherapy and radiation therapy. Chemotherapy-induced nausea and vomiting can be acute (within the first 24 hours), delayed (vomiting that occurs after 24 hours) and/or anticipatory. Anticipatory vomiting is a learned response, which means it happens in response to a stimulus, chemotherapy. With this type of nausea and vomiting, the symptoms usually occur after initial exposure to chemotherapy drugs and before subsequent treatments.
A specific location in the brain controls emesis (vomiting), called the vomiting center. Emesis occurs when the vomiting center receives a signal from the brain, the gastrointestinal tract, the heart and/or the inner ear, which detects motion. Chemotherapy causes the release of a substance called serotonin (5-HT), and of other chemicals in the small intestine, which through a series of signals stimulate the vomiting center in your brain to induce emesis.
The best way to treat nausea and vomiting is to prevent it from occurring in the first place. Many new and improved medicines for controlling nausea and vomiting, called antiemetics, have been developed over the last several years. These drugs block the signal in the brain that causes nausea and vomiting. As a result of widespread use of antiemetics, nausea and/or vomiting is not as severe and does not occur as frequently as in the past. There are many different kinds of antiemetics and you may need to try more than one before finding a prescription that works for you.
5-HT3 inhibitors: The 5HT-3 Inhibitors are the most effective antiemetics and constitute the single greatest advance in the management of nausea and vomiting in patients with cancer. These drugs are designed to block one or more of the signals that cause nausea and vomiting. The most sensitive signal during the first 24 hours after chemotherapy appears to be 5-HT3. Blocking the 5-HT3 signal is one approach to preventing acute emesis, or emesis that is severe, but relatively short-lived. Antiemetics that block 5-HT3, called 5-HT3 inhibitors, are the most effective agents developed to date for preventing emesis and are available to be administered orally or intravenously. The newest 5-HT3 inhibitor, Aloxi® (palonosetron), has a distinct advantage over the other 5-HT3 inhibitors because in addition to preventing acute nausea and vomiting, Aloxi® also prevents delayed nausea and vomiting, which occurs during the 2-5 days after treatment. 1,2 Aloxi® is the only drug in its class that is approved by the FDA for the treatment of delayed nausea and vomiting.
Other examples of FDA-approved 5-HT3 inhibitors include:
Other drug therapy approaches: Other drugs commonly used to prevent or treat nausea and vomiting, either alone or in combination with antiemetics, include:
There are several things you can do to prevent nausea and vomiting. First and foremost, make sure you receive and take your antiemetics as your doctor has ordered. Let your doctor or nurse know if your drugstore does not have them, you cannot afford to pay for them, or you are not sure how to take them. Also, call your doctor if you experience any of the following:
In addition to taking your medication, the following general suggestions may help you prevent or control nausea and vomiting:
Anticipatory nausea and vomiting is poorly controlled with standard antiemetic treatment. In some clinical studies, drugs that treat anxiety (benzodiazepines) have provided some relief. A number of non-drug approaches, also called cognitive and behavioral intervention, may help. These include:
Certain chemotherapy drugs are more likely to cause nausea and vomiting than others. Chemotherapy drugs are classified as mildly, moderately or highly likely to cause nausea and vomiting.
The table below lists the degree of nausea and vomiting patients would experience without effective antiemetic drugs. High-dose chemotherapy is almost always associated with a high probability of nausea and vomiting and appropriate antiemetics are indicated. Most chemotherapy treatment regimens use more than one drug. The degree of nausea and vomiting produced by a combination chemotherapy treatment regimen is typically greater than the amount of nausea expected from the single drug producing the greatest amount of nausea and vomiting.
|Drugs||Amount of nausea/vomiting|
|Trade Name||Generic name||None||Mild||Mod||High|
|Bexxar®||tositumomab iodine 131||X|
|Quadramet®||samarium 153 lexidronan||X|
1 Eisenberg P, Figueroa-Vadillo J, Zamora R, et al. Improved prevention of moderately emetogenic chemotherapy-induced nausea and vomiting with palonosetron, a pharmacologically novel 5-HT3 receptor antagonist: results of a phase III, single-dose trial versus dolasetron. Cancer. 2003;98:2473-2482.
2 Gralla R, Lichinitser M, Van der Vegt, S, et al. Palonosetron improves prevention of chemotherapy-induced nausea and vomiting following moderately emetogenic chemotherapy: results of a double-blind randomized phase III trial comparing single doses of palonosetron with ondansetron. Ann Oncol. 2003;14:1570-1577.
3 Hesketh PJ, Grunberg SM, Gralla RJ, Warr DG, et al. The oral neurokinin-1 antagonist aprepitant for the prevention of chemotherapy-induced nausea and vomiting: a multinational, randomized, double-blind, placebo-controlled trial in patients receiving high-dose cisplatin--the Aprepitant Protocol 052 Study Group. Journal of Clinical Oncology 2003 Nov 15;21(22):4112-9.
4 de Wit R, Herrstedt J, Rapoport B, Carides AD, et al. Addition of the oral NK1 antagonist aprepitant to standard antiemetics provides protection against nausea and vomiting during multiple cycles of cisplatin-based chemotherapy. Journal of Clinical Oncology. 2003 Nov 15;21(22):4105-11.