A retrospective drug utilization study in chemotherapy-induced nausea and vomiting

Authors

  • Ashwini A. Aher Department of Pharmacology, Government Cancer College and Hospital, Chhatrapati Sambhajinagar, Maharashtra, India
  • S. U. Razvi Department of Pharmacology, Government Cancer College and Hospital, Chhatrapati Sambhajinagar, Maharashtra, India
  • M. S. Baig Department of Pharmacology, Government Cancer College and Hospital, Chhatrapati Sambhajinagar, Maharashtra, India

DOI:

https://doi.org/10.18203/2320-6012.ijrms20251304

Keywords:

Chemotherapy, Nausea, Vomiting, 5-HT3 receptor antagonists, Corticosteroids

Abstract

Background: Chemotherapy-induced nausea and vomiting (CINV) significantly impacts patients' quality of life. Despite advancements in therapy, optimal management of CINV remains crucial. This study evaluates drug utilization patterns in CINV management in patients attending the government cancer hospital, Chhatrapati Sambhajinagar (Maharashtra). Objective were to evaluate the drug utilization patterns in CINV management amongst cancer patients.

Methods: Retrospective, cross-sectional observational study in 242 cancer patients attending the outpatient department in a government cancer hospital, Chhatrapati Sambhajinagar. The prescriptions were taken from the record section after the necessary approval of IEC and permissions. Prescriptions were evaluated as per WHO drug prescribing indicators.

Results: The 484 drugs were prescribed for CINV in 242 patients. Most patients were aged between 51-60 years (31.82%), followed by 41-50 years (26.86%). All drugs are prescribed under generic names. Three classes of drugs were identified as monotherapy or combination therapy. 5-HT3 receptor antagonists and corticosteroids were the two most frequently used classes, followed by NK1 receptor antagonists. In prescribing patterns, dual combination regimens of 5-HT3 receptor antagonists and corticosteroids were the most common (99.17%), followed by triple combination and monotherapy (0.41% each). Out of the total, 483 (99.79%) drugs were given by parenteral route and 1 (0.21%) by oral route.

Conclusions: Following standard protocols for CINV was noted. The use of 5-HT3 receptor antagonists (Granisetron) and corticosteroids (dexamethasone) in combination was common, suggesting a pattern of adherence to guidelines and improving patient care.

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References

Baker PD, Morzorati SL, Ellett ML. The Pathophysiology of Chemotherapy-Induced Nausea and Vomiting: Gastroenterol Nursing. 2005;28(6):469-80. DOI: https://doi.org/10.1097/00001610-200511000-00003

Aguilar EA, Figueiras MC, Cortes-Funes H, García EDR, Vilaplana PG, Guillém V, et al. Clinical practice guidelines on antiemetics in oncology. Expert Rev Anticancer Therapy. 2005;5(6):963-72. DOI: https://doi.org/10.1586/14737140.5.6.963

Hesketh PJ. Chemotherapy-Induced Nausea and Vomiting. N Engl J Med. 2008;358(23):2482-94. DOI: https://doi.org/10.1056/NEJMra0706547

Navari RM. Management of chemotherapy-induced nausea and vomiting: focus on newer agents and new uses for older agents. Drugs. 2013;73(3):249-62. DOI: https://doi.org/10.1007/s40265-013-0019-1

Rudd JA, Nalivaiko E, Matsuki N, Wan C, Andrews PL. The involvement of TRPV1 in emesis and anti-emesis. Temperature. 2015;2(2):258-76. DOI: https://doi.org/10.1080/23328940.2015.1043042

Aapro M, Johnson J. Chemotherapy-Induced Emesis in Elderly Cancer Patients: The Role of 5-HT3-Receptor Antagonists in the First 24 Hours. Gerontology. 2005;51(5):287-96. DOI: https://doi.org/10.1159/000086364

Herrstedt J, Celio L, Hesketh P, Zhang L, Navari R, Chan A, et al. 2023 updated MASCC/ESMO consensus recommendations: prevention of nausea and vomiting following high-emetic-risk antineoplastic agents. Support Care Cancer. 2024;32(1):47. DOI: https://doi.org/10.1007/s00520-023-08221-4

Herrstedt J, Roila F, Warr D, Celio L, Navari RM, Hesketh PJ, et al. 2016 Updated MASCC/ESMO Consensus Recommendations: Prevention of Nausea and Vomiting Following High Emetic Risk Chemotherapy. Support Care Cancer. 2017;25(1):277-88. DOI: https://doi.org/10.1007/s00520-016-3313-0

Doggrell SA. Granisetron in the treatment of chemotherapy-induced nausea and vomiting (CINV) – is there still a role after comparison with palonosetron? Expert Opinion Pharmacot. 2017;18(10):1019-26. DOI: https://doi.org/10.1080/14656566.2017.1342809

Piechotta V, Adams A, Haque M, Scheckel B, Kreuzberger N, Monsef I, et al. Antiemetics for adults for prevention of nausea and vomiting caused by moderately or highly emetogenic chemotherapy: a network meta-analysis. Cochrane Pain, Palliative and Supportive Care Group, editor. Cochrane Database Syst Rev. 2021;2022(1):CD012775. DOI: https://doi.org/10.1002/14651858.CD012775.pub2

Barbour SY. Corticosteroids in the Treatment of Chemotherapy-Induced Nausea and Vomiting. J Natl Compr Canc Netw. 2012;10(4):493-9. DOI: https://doi.org/10.6004/jnccn.2012.0049

Grunberg S, Clark-Snow RA, Koeller J. Chemotherapy-induced nausea and vomiting: contemporary approaches to optimal management: Proceedings from a symposium at the 2008 Multinational Association of Supportive Care in Cancer (MASCC) Annual Meeting. Support Care Cancer. 2010;18(S1):1-10. DOI: https://doi.org/10.1007/s00520-009-0807-z

Vaid AK, Gupta S, Doval DC, Agarwal S, Nag S, Patil P, et al. Expert Consensus on Effective Management of Chemotherapy-Induced Nausea and Vomiting: An Indian Perspective. Front Oncol. 2020;10:400. DOI: https://doi.org/10.3389/fonc.2020.00400

Herrstedt J, Clark-Snow R, Ruhlmann CH, Molassiotis A, Olver I, Rapoport BL, et al. 2023 MASCC and ESMO guideline update for the prevention of chemotherapy- and radiotherapy-induced nausea and vomiting. ESMO Open. 2024;9(2):102195. DOI: https://doi.org/10.1016/j.esmoop.2023.102195

Hesketh PJ, Van Belle S, Aapro M, Tattersall FD, Naylor RJ, Hargreaves R, et al. Differential involvement of neurotransmitters through the time course of cisplatin-induced emesis as revealed by therapy with specific receptor antagonists. Europ J Cancer. 2003;39(8):1074-80. DOI: https://doi.org/10.1016/S0959-8049(02)00674-3

Roila F, Molassiotis A, Herrstedt J, Aapro M, Gralla RJ, Bruera E, et al. 2016 MASCC and ESMO guideline update for the prevention of chemotherapy-and radiotherapy-induced nausea and vomiting and of nausea and vomiting in advanced cancer patients. Ann Oncol. 2016;27:v119-33. DOI: https://doi.org/10.1093/annonc/mdw270

Bošnjak SM, Gralla RJ, Schwartzberg L. Prevention of chemotherapy-induced nausea: the role of neurokinin-1 (NK1) receptor antagonists. Support Care Cancer. 2017;25(5):1661-71. DOI: https://doi.org/10.1007/s00520-017-3585-z

Chandrasekaran Y, Dharmalingam Jothinathan MK. Advancements in managing chemotherapy-induced nausea and vomiting: From efficacy to cost-effectiveness. Oral Oncol Rep. 2024;10:100497. DOI: https://doi.org/10.1016/j.oor.2024.100497

Coluzzi F, Mattia C. Management of Chemotherapy-Induced Nausea and Vomiting in Patients Receiving Multiple-Day Highly or Moderately Emetogenic Chemotherapy: Role of Transdermal Granisetron. Future Oncol. 2016;12(16):1865-76. DOI: https://doi.org/10.2217/fon-2016-0097

Aapro M, Karthaus M, Schwartzberg L, Bondarenko I, Sarosiek T, Oprean C, et al. NEPA, a fixed oral combination of netupitant and palonosetron, improves control of chemotherapy-induced nausea and vomiting (CINV) over multiple cycles of chemotherapy: results of a randomized, double-blind, phase 3 trial versus oral palonosetron. Support Care Can. 2017;25(4):1127-35. DOI: https://doi.org/10.1007/s00520-016-3502-x

Schussel V, Kenzo L, Santos A, Bueno J, Yoshimura E, De Oliveira Cruz Latorraca C, et al. Cannabinoids for nausea and vomiting related to chemotherapy: Overview of systematic reviews. Phytotherapy Res. 2018;32(4):567-76. DOI: https://doi.org/10.1002/ptr.5975

Natale JJ. Overview of the prevention and management of CINV. Am J Manag Care. 2018;24(18):S391-7.

Caracuel F, Muñoz N, Baños U, Ramirez G. Adherence to antiemetic guidelines and control of chemotherapy-induced nausea and vomiting (CINV) in a large hospital. J Oncol Pharm Pract. 2015;21(3):163-9. DOI: https://doi.org/10.1177/1078155214524809

Adel N. Overview of Chemotherapy-Induced Nausea and Vomiting and Evidence-Based Therapies. Am J Manag Care. 2017;23(14):S259-65.

Craver C, Gayle J, Balu S, Buchner D. Clinical and economic burden of chemotherapy-induced nausea and vomiting among patients with cancer in a hospital outpatient setting in the United States. J Med Econom. 2011;14(1):87-98. DOI: https://doi.org/10.3111/13696998.2010.547237

Gupta K, Walton R, Kataria SP. Chemotherapy-Induced Nausea and Vomiting: Pathogenesis, Recommendations, and New Trends. Cancer Treat Res Commun. 2021;26:100278. DOI: https://doi.org/10.1016/j.ctarc.2020.100278

Razvi Y, Chan S, McFarlane T, McKenzie E, Zaki P, DeAngelis C, et al. ASCO, NCCN, MASCC/ESMO: a comparison of antiemetic guidelines for the treatment of chemotherapy-induced nausea and vomiting in adult patients. Support Care Cancer. 2019;27(1):87-95. DOI: https://doi.org/10.1007/s00520-018-4464-y

Hesketh PJ, Kris MG, Basch E, Bohlke K, Barbour SY, Clark-Snow RA, et al. Antiemetics: American Society of Clinical Oncology Clinical Practice Guideline Update. J Clin Oncol. 2017;35(28):3240-61. DOI: https://doi.org/10.1200/JCO.2017.74.4789

Karthaus M, Schiel X, Ruhlmann CH, Celio L. Neurokinin-1 receptor antagonists: review of their role for the prevention of chemotherapy-induced nausea and vomiting in adults. Expert Rev Clin Pharmacol. 2019;12(7):661-80. DOI: https://doi.org/10.1080/17512433.2019.1621162

Grunberg SM, Deuson RR, Mavros P, Geling O, Hansen M, Cruciani G, et al. Incidence of chemotherapy‐induced nausea and emesis after modern antiemetics: Perception versus reality. Cancer. 2004;100(10):2261-668. DOI: https://doi.org/10.1002/cncr.20230

Di Francia R, De Monaco A, Saggese M, Iaccarino G, Crisci S, Frigeri F, et al. Pharmacological Profile and Pharmacogenomics of Anti-Cancer Drugs Used for Targeted Therapy. CCDT. 2018;18(5):499-511. DOI: https://doi.org/10.2174/1568009617666170208162841

Giuliani J, Bonetti A. Netupitant plus palonosetron is a cost-effective treatment for the prophylaxis of chemotherapy-induced nausea and vomiting in highly and moderately emetogenic cancer treatment. Expert Rev Pharmacoeconom Outcomes Res. 2019;19(5):505-8. DOI: https://doi.org/10.1080/14737167.2019.1650644

Molassiotis A, Coventry PA, Stricker CT, Clements C, Eaby B, Velders L, et al. Validation and Psychometric Assessment of a Short Clinical Scale to Measure Chemotherapy-Induced Nausea and Vomiting: The MASCC Antiemesis Tool. J Pain Symptom Management. 2007;34(2):148-59. DOI: https://doi.org/10.1016/j.jpainsymman.2006.10.018

Vandenbroucke JP. When are observational studies as credible as randomised trials? The Lancet. 2004;363(9422):1728-31. DOI: https://doi.org/10.1016/S0140-6736(04)16261-2

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Published

2025-04-29

How to Cite

Aher, A. A., Razvi, S. U., & Baig, M. S. (2025). A retrospective drug utilization study in chemotherapy-induced nausea and vomiting. International Journal of Research in Medical Sciences, 13(5), 2010–2017. https://doi.org/10.18203/2320-6012.ijrms20251304

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Original Research Articles