Management of Chemotherapy-Induced Nausea and Vomiting

1. Front Matter

   Pages i-viii

   PDF

2. Introduction

   • Rudolph M. Navari

   Pages 1-3

3. The Physiology and Pharmacology of Nausea and Vomiting Induced by Anticancer Chemotherapy in Humans

   • Paul L. R. Andrews, John A. Rudd

   Pages 5-44

4. First-Generation 5-HT3 Receptor Antagonists

   • Roy Chen, Kathy Deng, Harry Raftopoulos

   Pages 45-62

5. Palonosetron

   • Lee Schwartzberg

   Pages 63-84

6. The Role of Neurokinin-1 Receptor Antagonists in CINV

   • Bernardo Leon Rapoport

   Pages 85-105

7. Olanzapine for the Prevention of Chemotherapy-Induced Nausea and Vomiting

   • Rudolph M. Navari

   Pages 107-120

8. Gabapentin for the Prevention of CINV

   • Thomas J. Guttuso Jr.

   Pages 121-133

9. Prevention of CINV in Patients Receiving High-Dose Multiple-Day Chemotherapy

   • Luigi Celio

   Pages 135-156

10. Clinical Management of CINV

    • Rudolph M. Navari

    Pages 157-162

11. Treatment of Chemotherapy-Induced Nausea

    • Rudolph M. Navari

    Pages 163-176

12. Conclusions

    • Rudolph M. Navari

    Pages 177-178

13. Future Directions

    • Rudolph M. Navari

    Pages 179-181

This book provides a comprehensive review of new agents, a detailed description of new uses of current agents, and an integration of the available agents in clinical practice. A description of a detailed clinical approach provides clinical practitioners with the most up-to-date recommendations for the prevention and treatment of chemotherapy-induced nausea and vomiting (CINV) in various clinical settings.


CINV is one of the most feared treatment related toxicities. Patient surveys for the past thirty years consistently demonstrate patients’ perception of deterioration in quality of life due to chemotherapy treatments. The introduction of the antiemetics, serotonin 5-HT3 receptor antagonists and the neurokinin-1 receptor antagonists, have improved the control of chemotherapy-induced emesis, but the treatment of chemotherapy-induced nausea remains a significant clinical problem. Patients continue to have quality of life issues which prevent normal functioning during active treatment. New agents such as the second generation 5-HT3 receptor antagonist palonosetron and the new neuroknin-1 receptor antagonists rolapitant and netupitant are being introduced into clinical practice, and it is anticipated that these new agents will improve the control of CINV. Agents such as olanzapine (a FDA approved anti-psychotic), gabapentin (a FDA approved neuroleptic), and ginger (a food additive), which have been used primarily for other indications, are now being tested as potential, effective antiemetics. 


This work represents the first available comprehensive summary that details all new antiemetic agents and, particularly, their clinical role in treating patients; an important reference for practitioners seeking to improve the quality of life of patients undergoing chemotherapy.

• 5-Hyroxytryptamine-3 Receptor Antagonists
• Anti-emetics
• Dexamethasone
• Gabapentin
• Multi-day Chemotherapy
• Neurokinin-1 Receptor Antagonists
• Olanzapine
• pharmacotherapy

• Indiana University School of Medicine, South Bend, USA

  Rudolph M. Navari

Dr. Navari received the Ph.D. degree at the University of Virginia, and the M.D. degree at the Medical College of Virginia.  He received training in internal medicine at the University of Alabama in Birmingham, and was a Fellow in Hematology and Oncology at the Fred Hutchinson Cancer Research Center, University of Washington School of Medicine.  He is board certified in internal medicine and medical oncology.  From 1983 to 1998, he served on the Clinical Faculty of the University of Alabama Birmingham and was a practicing medical oncologist in the Simon-Williamson Clinic.  During this time, he was Chairman of the Department of Medicine and President of the Simon-Williamson Clinic, Director of the Bone Marrow Transplantation Program and Director of the Comprehensive Cancer Program at Baptist Medical Center. In 1997, he was elected a Fellow of the American College of Physicians.  During 1998-99, he was a Fellow in Clinical Medical Ethics in the MacLean Center for Clinical Medical Ethics at the University of Chicago.  He joined the faculty of the College of Science of the University of Notre Dame (UND) in 1999 as Director of the Walther Cancer Research Center. He was appointed Associate Dean, College of Science, in 2000. In July, 2005, he became Professor of Medicine, Assistant Dean and Director, Indiana University School of Medicine South Bend (IUSM SB), and Adjunct Professor of Biochemistry, University of Notre Dame. In 2011, he was appointed Clinical Director, Harper Cancer Research Institute, a partnership between IUSM SB and UND. He was promoted to Associate Dean in 2012. Along with the medical students at IUSM SB, he founded the IUSM SB Student Outreach Clinic in 2013 and was appointed the Clinic’s first Medical Director.

In 2014, he joined the World Health Organization as Director of the Cancer Care Program, Eastern Europe. In 2015, he was appointed Director of the Cancer Care Program, Central and South America.

Dr. Navari's research interests include supportive care in clinical oncology, development of antiemetics, palliative care, and the doctor-patient relationship in clinical oncology.  He has published over one hundred and thirty peer reviewed articles, with the most recent dealing with supportive care issues in clinical oncology.

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