Best practice management of CINV in oncology patients: I. Physiology and treatment of CINV. Multiple neurotransmitters and receptors and the need for combination therapeutic approaches.

Chemotherapy-induced nausea and vomiting (CINV) involves multiple neurotransmitter and receptor systems; thus, its optimal treatment is likely to require a combination of therapies targeting multiple systems. Antiemetic regimens have evolved from use of dopamine antagonists alone to combination regimens such as a corticosteroid plus an antagonist of the serotonin (5-hydroxytryptamine) type 3 receptor or this combination with a neurokinin-1 receptor antagonist. The net result is that antiemetic efficacy has markedly increased with the addition of each new class of agent to treatment regimens. Further research is needed to determine optimal uses of available classes and agents for managing CINV, to elucidate the roles of additional neurotransmitters and receptors in both nausea and vomiting, and to develop new antiemetic agents.