Table 1. Key Principles of Antiemetics for CINV.

First and foremost, CINV prophylaxis should be initiated prior to chemotherapy with > 10% risk of CINV (i.e., LEC, MEC, and HEC). Antiemetic(s) (either as monotherapy or in combination) should be continued for long enough to cover the duration of emetic risk. For combination chemotherapy regimens, the agent with the highest emetogenic potential should guide selection of antiemetic prophylaxis. For breakthrough CINV, general consensus is to reevaluate emetic risk, disease status, concurrent illnesses, and medications, and ascertain that the best regimen is being administered for the emetic risk. It is also a general consensus to add an antiemetic with a different mechanism of action than that of those used in the previous cycle of chemotherapy. » Olanzapine is the first-line agent for management of breakthrough CINV.

Note. CINV = chemotherapy-induced nausea and vomiting; LEC = low emetogenic chemotherapy; MEC = moderately emetogenic chemotherapy; HEC = highly emetogenic chemotherapy.