Richard Gralla, MD, Medical Director, Quality of Life Research Associates, New York City, discusses efforts that are currently underway to improve compliance to guidelines while also optimizing the care that is provided to patients suffering from chemotherapy-induced nausea and vomiting (CINV).

Gralla raises the question of whether the optimal dose for neurokinin 1 (NK1)-receptor antagonist has been reached. Two currently approved antiemetic NK1-receptor antagonist are aprepitant (Emend) and fosaprepitant. Additionally, rolapitant and netupitant are currently being studied in high-risk patients for the prevention of CINV.

A larger dose of an NK1-agonist could potentially result in better distribution in the brain and more effective care, Gralla adds. Other receptors are also being researched using gabapentin and olanzapine, which look at multiple receptors. These new therapies may also prove effective at controlling both emesis and nausea.

An important aspect for supportive care in cancer is whether the guidelines are being followed. Closely following the guidelines that are in place may help guarantee that the same results recorded in the trials are translated into practice. In the future, it is possible that guidelines will be built into electronic ordering systems, making it difficult not to follow the guidelines, Gralla believes.

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Dr. Richard Gralla, from Quality of Life Research Associates, on Future Advances in chemotherapy-induced nausea and vomiting Prevention

Dr. Gralla on Future Advances in CINV Prevention

Richard Gralla, MD, Medical Director, Quality of Life Research Associates, New York City, discusses efforts that have been made to control chemotherapy-induced nausea and vomiting (CINV) while stressing that more advances have been developed that control emesis than nausea.

Progress has been made at managing both nausea and vomiting; however, it has become clear that the two are separate entities. Going back to the basics, textbooks suggest that the symptoms are anorexia, nausea, and vomiting, in that order. These symptoms may share pathways but each appears to have its own individual mechanism as well.

Gralla suggests that inhibiting fewer pathways such as neurokinin 1 (NK1) and serotonin, may help with vomiting or nausea but is not enough. Other pathways may be implicated and still need to be discovered and investigated in trials focusing specifically on nausea.

Dr. Richard Gralla, from the Quality of Life Research Associates, on Chemotherapy-Induced Nausea and Vomiting.


Richard Gralla, MD

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Dr. Gralla on Future Advances in CINV Prevention

Dr. Gralla on Chemotherapy-Induced Nausea and Vomiting