Nausea - No Longer an Inevitable Side Effect of Chemotherapy for Anal Cancer
by C.H. Weaver M.D.
It’s no surprise that cancer patients name nausea and vomiting among the side effects of chemotherapy that they most fear. And though its impact on patient comfort and quality of life is a significant concern, chemotherapy-induced nausea and vomiting (CINV) can also have a major adverse effect on the course of treatment and subsequent outcomes. Because severe CINV can result in the delay or complete halt of a patient’s chemotherapy regimen, this side effect can drastically interfere with treatment.
At a recent annual meeting of the Oncology Nursing Society, more than half of oncology nurses surveyed reported that they had interrupted or completely stopped patients’ chemotherapy due to CINV. This finding underscores the dire consequences of CINV. For optimal treatment, CINV must be effectively managed.
Preventing and Treating CINV
Prevention and treatment of CINV often begins before chemotherapy is administered. Drugs used to prevent nausea and vomiting are call antiemetics and can be delivered intravenously (IV), orally (in pill form), or through a transdermal patch (a patch that delivers medication through the skin).
Some of the more common antiemetic medications are the following:
- 5-HT3 receptor antagonists. This class of drugs provided a major breakthrough in the prevention of acute CINV. Drugs in this class include Anzemet® (dolasetron), Kytril® (granisetron) and Sancuso® (granisetron transdermal system), Zofran® (ondansetron), and Aloxi® (palonosetron).
- NK-1 receptor antagonist. Emend® (aprepitant) is the first of a newer class of drugs known as NK-1 receptor antagonists. It has been shown to add to the activity of 5-HT3 receptor antagonists and dexamethasone and is effective against both acute and delayed CINV.
- Corticosteroids. Dexamethasone is often used alone or in combination with other antiemetic drugs for the prevention of both acute and delayed CINV.
The choice of which drugs to use (if any) and when to use them will depend on the type, dosages, and schedule of the chemotherapy you receive.
Expanding Options: The Sancuso Patch
A more recent option for delivery of antiemetic medications is a patch that sticks to the skin and delivers a steady dose of the highly effective 5HT3 antagonist granisetron over a several-day period. Research suggests that the Sancuso® patch is as effective as oral granisetron.
The Sancuso patch may be a particularly convenient option for managing CINV. It works for up to five days, allowing a patient to apply the patch before chemotherapy begins. In addition to being more convenient than IV forms of medicine, Sancuso may help patients avoid unnecessary trips to the doctor for additional antiemetic therapy. Sancuso is also better for use at home than oral medication because you don’t have to remember to take a pill; instead, the patch delivers a steady stream of antiemetic therapy to prevent breakthrough nausea and vomiting. Swallowing pills may also be difficult for individuals experiencing or worried about CINV. Importantly, research has shown that it’s feasible to combine the Sancuso patch with IV administration of granisetron; this combination approach further expands options for managing CINV with Sancuso.
 ProStrakan Pharamceuticals [press release]. More than half of nurses have stopped or delayed patients’ chemotherapy treatment, new survey shows. http://www.prostrakan-usa.com/PDFs/Press_Releases/021908.pdf. Accessed June 2008.
 Howell J, O’Mahony B, Gutierrez-Esteinou R. Co-administration of transdermal granisetron and intravenous (IV) granisetron in healthy subjects: a Phase I pharmacokinetic, tolerability and safety study. Presented at the Fifth Annual Chicago Supportive Oncology Conference, October 1–3 2009.