15 1 Part Two: Chemotherapy-induced nausea and vomiting Nausea and vomiting are serious side effects of cancer chemotherapy that can cause significant negative impacts onpatients’ QoL andon their ability to tolerateandcomplywith therapy [44-46]. Despite the substantial progress in CINV prophylactic strategies, as many as 40% of patients with cancer still experience nausea, vomiting, or both following receipt of chemotherapy [47]. CINV is caused by neurotransmitters and chemical substances stimulating the receptors in either the vomiting center or chemoreceptor trigger zone (Figure 2). Such substances include dopamine, serotonin, histamine, acetylcholine, and substance P [48-50]. Antiemetic agents are designed to target one of these relevant receptors. Phenothiazine andmetoclopramide, agentswidely inuse fromthe 1980s, inhibit the action of dopamine [51]. Figure 2. Pathophysiology of chemotherapy-induced nausea and vomiting. From N Engl J Med, Volume No. 374, Page No. 1357. Navari RM, Aapro M, Antiemetic prophylaxis for chemotherapy-induced nausea and vomiting, Reprinted with permission.
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