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By Melissa Tennen, HealthAtoZ writer
Doctors have a new medication to help people who are suffering nausea and vomiting caused by chemotherapy.
Emend® (aprepitant), approved in March 2003 by the Food and Drug Administration, helps prevent chemotherapy-induced nausea and vomiting (CINV), especially delayed nausea and vomiting. This usually occurs within the first five days after a first dose of chemotherapy.
"We have never had a drug like this before. It's exciting. We will have a whole new family of drugs to work with," says Steven Grunberg, M.D., investigator in the study and professor of medicine at the division of hematology/oncology at the University of Vermont in Burlington. "We are going to be able to take better care of our patients."
Grunberg explains doctors did not have an effective drug in their arsenal to mitigate delayed CINV, which often occurs between the second day and fifth day after a round of chemotherapy. Doctors typically prescribe medications before a chemotherapy treatment to help with acute vomiting and nausea.
"Some people feel okay when they leave the hospital," says Pam Kiedziera, R.N., M.S.N., a pain management clinical nurse specialist at the Fox Chase Cancer Center in Philadelphia. "But just when people start to think 'This isn't too bad', they go home and then start to get nauseous and start to vomit, usually 24 to 48 hours after the chemotherapy. They become incapacitated - they don't want to work, they don't want to get up, they don't want to do anything. It really impacts their personal life. And it's also hard on the spouse and the children. This will give people a better quality of life."
Doctors and researchers believe neurotransmitters in the brain and gastrointestinal tract play a role in causing vomiting and nausea. Researchers suspect aprepitant may work on a brain receptor called neurokinin 1. Other drugs work on receptors such as the serotonin receptor. Another new drug for CINV is Aloxi® (palonosetron).
Cancer is usually treated with different approaches such as radiation, surgery and chemotherapy, which can cure some types of cancer but not all. Sometimes, chemotherapy is used to slow the growth of cancer cells or to keep the cancer from spreading to other parts of the body. In other cases, when a cancer has been removed by surgery, chemotherapy may be used to keep the cancer from coming back. This is known as adjuvant therapy. Chemotherapy also can ease the symptoms of cancer. However, the treatments themselves may harm cells in hair and bone marrow, causing hair loss and a tired feeling; may harm cells of the skin and mouth, causing sores in the mouth, and cause dry skin and dry hair; and may harm cells in the stomach and intestines, causing people to feel nauseated. But vomiting and nausea are among patients' chief complaints.
Some forms of chemotherapy cause most patients to vomit if they do not receive anti-vomiting medicine prior to treatment. However, about 50 percent of patients receiving this kind of chemotherapy have delayed nausea and vomiting, according to a study in the Journal of Clinical Oncology.
"Because they don't feel good, they might not be taking the right doses of medication at the right times. The treatments lose efficacy in helping to stall or stop the disease," Kiedziera says.
Another problem with the nausea and vomiting, she notes, is that people may neglect other medications such as statins to help control cholesterol or blood pressure medicines or people may not be able to keep them down. Plus, dehydration creates a dangerous situation that could land them in the hospital. "It's no secret that oncologists use drugs that make people sick to their stomachs," says Robert Chapman, M.D., an oncologist with Henry Ford Health System in Detroit, who welcomes the drug. "This will be a drug that adds to the armament that we already have. It won't replace what we have but will add to it." Another new medication, Aloxi® (palonostron HCI injection), is a single dose drug given at the time of chemotherapy with other anti-nausea/vomiting drugs to help prevent nausea and vomiting caused by chemotherapy.
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External Sources
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The American Cancer Society
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The National Cancer Institute
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Fox Chase Cancer Center
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Henry Ford Health System
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Dollinger M, Rosenbaum, EH, Tempero M., et al. Everyone's Guide to Cancer Therapy, Fourth Edition, Kansas City, Missouri: Andrews McMeel Publishing, 2002
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Rosenbaum, EH, Rosenbaum, I, Everyone's Guide to Supportive Cancer Care, Fourth Edition, Kansas City, Missouri: Andrew McMeel Publishing, 2005
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This article was reviewed and updated June 2007.
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