Abstract

CHEMOTHERAPY-INDUCED NAUSEA AND VOMITING: A COMPREHENSIVE REVIEW OF PATHOPHYSIOLOGY AND THERAPY

Chithira G.*, Hariganesh T., Karthikeyan R., Balaji D., Madhan S., Kevin Antonio Durai V., Elamaran C. and Ragul Ezhumalai

ABSTRACT

Chemotherapy-induced nausea and vomiting (CINV) remain among the most distressing side effects of cancer treatment, significantly affecting patients’ quality of life and treatment adherence. This review provides a comprehensive overview of CINV, including its pathophysiology, clinical manifestations, and current management strategies.[1] Chemotherapeutic agents can activate peripheral and central pathways, particularly through the gastrointestinal tract and central nervous system, resulting in nausea and vomiting.[2] CINV is categorized into several phases: the acute phase occurs within 24 hours of chemotherapy, the delayed phase appears after 24 hours and may persist for days, and the anticipatory phase is driven by psychological conditioning.[3-6] Other forms such as breakthrough, refractory, and cyclic CINV are also discussed, emphasizing their clinical challenges and the need for personalized approaches. Management involves the use of multiple antiemetic agents, including 5-HT3 receptor antagonists, NK1 receptor antagonists, and corticosteroids, which are selected based on patient risk factors, chemotherapy regimen, and history of nausea. Evidence-based guidelines highlight the importance of tailoring antiemetic therapy to individual needs to enhance treatment outcomes and reduce the burden of CINV.[7-9] This review underlines the need for a holistic, patient-centered approach to CINV management, which not only improves symptom control but also supports better adherence to cancer therapy and enhances overall patient well-being.[10-12]

Keywords: Chemotherapy-induced nausea and vomiting (CINV), Antiemetics, Acute phase, Delayed phase, Refractory CINV, Breakthrough CINV, NK1 receptor antagonist, 5-HT3 antagonist, Cancer supportive care, Quality of life.