New Formulations Improve Management of Chemotherapy-Induced Nausea and Vomiting

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CINV still affects many patients, especially in the delayed phase.
CINV still affects many patients, especially in the delayed phase.

Recent updates in antiemetic guidelines and the development of newer antiemetics have improved treatment of chemotherapy-induced nausea and vomiting (CINV), according to a new study published in the journal Cancer Management and Research. Researchers report that granisetron extended-release subcutaneous (GERSC), a recently approved 5-hydroxytryptamine type 3 (5HT3)-receptor antagonist (RA) formulation, may help better ameliorate acute and delayed nausea and vomiting. 

“Even with all the advances in the antiemetic space over the last 2 decades, some patients still suffer from CINV, especially in the delayed phase. Newer agents, if used appropriately and consistently, should help to reduce delayed CINV,” said study co-author James Gilmore, PharmD, Georgia Cancer Specialists, Atlanta.

THE STUDY

Dr Gilmore and colleagues examine new therapeutic strategies for CINV involving 5HT3-RAs as well as other agents. The researchers note that CINV remains poorly controlled in a significant number of patients receiving moderately emetogenic chemotherapy (MEC) or highly emetogenic chemotherapy (HEC). They report that nausea and delayed-phase CINV (24 to 120 hours after chemotherapy) are the most difficult to control. 

The researchers outline the national guidelines, which include antiemesis guideline recommendations for HEC from the the National Comprehensive Cancer Network (NCCN) and American Society of Clinical Oncology (ASCO). The 2 groups include a 4-drug regimen (5HT3-RA, neurokinin 1 [NK1]-RA, dexamethasone, and olanzapine) for HEC. However, they recommend a 3-drug regimen (5HT3-RA, NK1-RA, and dexamethasone) for some MEC regimens.Dr Gilmore and colleagues report that clinician awareness of the advantages and disadvantages of the various agents is imperative for effectively managing this adverse effect. 

WHAT WAS LEARNED

The researchers report that 5HT3-RA agents have dramatically improved CINV in the acute phase (0 to 24 hours after chemotherapy). However, their efficacy tends to decline in the delayed phase. Dr Gilmore said newer formulations are able to extend 5HT3-RA efficacy into the delayed phase. “With all the new choices available today to help us manage CINV, it is very important that all members of the healthcare team are  fully educated about guideline recommendations and the most appropriate way to incorporate all the new antiemetics into the standard regimens used in our patients,” Dr Gilmore told Oncology Nurse Advisor.


GERSC is indicated for use with other antiemetics to prevent acute and delayed nausea and vomiting associated with initial and repeat courses of MEC and anthracycline-cyclophosphamide combination regimens. GERSC is the most recently approved 5HT3-RA, and it provides slow controlled release of therapeutic granisetron concentrations for 5 or more days. Currently, GERSC is included in the NCCN and ASCO guidelines for MEC and HEC, and NCCN grants it preferred status for MEC in the absence of an NK1-RA.  

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