The evolving landscape of antiemetic prophylaxis for chemotherapy-induced nausea and vomiting: inspiration from cisplatin-based antiemetic and non-antiemetic trials

Despite the significant advancements in antiemetic regimens for preventing chemotherapy-induced nausea and vomiting (CINV), over 40% of cancer patients undergoing chemotherapy still experience CINV in clinical practice. To figure out underlying reasons and outline the landscape of antiemetic prophylaxis for CINV, our focus centered on cisplatin, one of the most commonly used highly emetogenic chemotherapy drugs. We aimed to elucidate trends in CINV management by analyzing data extracted from cisplatin-based clinical trials.

We extracted CINV-related data from 156 eligible randomized clinical trials, comprising 39 antiemetic trials and 117 non-antiemetic trials, all with patients undergoing high-dose cisplatin-based chemotherapy. Subsequently, we conducted separate analyses of the extracted CINV data within antiemetic and non-antiemetic trial groups, as well as comparisons between them.

Over the years, both antiemetic and non-antiemetic trials showed significant improvements in no-vomiting rates, although gains in no-nausea rates were more modest. Notably, antiemetic trials frequently underreported outcomes related to nausea control. There was a distinct yet gradually narrowing disparity in vomiting control rates between antiemetic and non-antiemetic trials during the same time frame. While non-antiemetic trials achieved comparable CINV control rates using the same antiemetic regimen as antiemetic trials, they exhibited significantly greater variations in no-vomiting and no-nausea rates.

The landscape of CINV management in cisplatin-based chemotherapy has evolved significantly alongside improvements in antiemetic agents. Substantial progress has been made in emesis control within both antiemetic and non-antiemetic cisplatin-based clinical trials. More attention should be paid on the chemotherapy induced nausea, and multiple approaches are needed to increase guideline adherence in future clinical practice.