Chemotherapy Induced Nausea and Vomiting in Children: A Literature Review and Recommendation for Antiemetic Prophylaxis in Resource Limited Countries

Abstract

Chemotherapy induced nausea and vomiting (CINV) are the most common side effects that impacts quality of life in children receiving cancer treatment. Inadequately controlled CINV impairs functional activity increases the healthcare utilization and compromises treatment adherence. The availability of new antiemetic agents results in substantially improvement of emetic control; however, in real-world practice, many developing countries have limited access to newly-developed antiemetic agents. This is a major obstacle in achieving adequate CINV control. Recent studies have recommended the “triple therapy” regimen (a 5-HT3 antagonist, dexamethasone, and a neurokinin-1 antagonist), as the backbone for antiemetic prophylaxis. Olanzapine, an atypical antipsychotic drug that improves CINV control in adult cancer patients. Together with ‘triple therapy” olanzapine is now recommended as the first line CINV prophylaxis in adults receiving highly emetogenic chemotherapy. Herein, we reviewed the recent published guidelines for the prevention and treatment of CINV in children. Furthermore, due to limited drug accessibility to neurokinin-1 antagonists, we proposed an institutional CINV guideline to replace the neurokinin-1 antagonist with olanzapine, which might be more reasonable in terms of economic constraints in resource limited countries.