Metagenomics and chemotherapy‐induced nausea: A roadmap for future research

Abstract

Uncontrolled chemotherapy-induced nausea and vomiting can reduce patients' quality of life and may result in premature discontinuation of chemotherapy. Although nausea and vomiting are commonly grouped together, research has shown that antiemetics are clinically effective against chemotherapy-induced vomiting (CIV) but less so against chemotherapy-induced nausea (CIN). Nausea remains a problem for up to 68% of patients who are prescribed guideline-consistent antiemetics. Despite the high prevalence of CIN, relatively little is known regarding its etiology independent of CIV. This review summarizes a metagenomics approach to the study and treatment of CIN with the goal of encouraging future research. Metagenomics focuses on genetic risk factors and encompasses both human (ie, host) and gut microbial genetic variation. Little work to date has focused on metagenomics as a putative biological mechanism of CIN. Metagenomics has the potential to be a powerful tool in advancing scientific understanding of CIN by identifying new biological pathways and intervention targets. The investigation of metagenomics in the context of well-established demographic, clinical, and patientreported risk factors may help to identify patients at risk and facilitate the prevention and management of CIN.

Liujunanwei decoction attenuates cisplatin-induced nausea and vomiting in a Rat-Pica model partially mediated by modulating the gut micsrobiome

“…As gastrointestinal disorders, for instance, diarrhea or constipation frequently occur in patients receiving chemotherapy, and investigations have shown that the gut microbiome plays a pivotal role in mediating chemotherapyinduced side effects, including nausea and vomiting (Hong et al, 2019;Crowder et al, 2021). Cisplatin is known to inhibit the growth of both Gram-negative and Gram-positive bacterial strains, such as some Bacillus and E. coli, and may induce dysbiosis (Joyce et al, 2010).…”

Mitigating acute chemotherapy-associated adverse events in patients with cancer

“…94,95 , ASCO and Krager. sickness during pregnancy, and individuals with a history of motion sickness or anxiety [138][139][140] . Additional risk factors include fluid and electrolyte imbalances, dehydration, malnutrition, serious infections, uraemia, and tumour invasion of the gastrointestinal tract, liver or CNS 138 .…”

“…The antipsychotic agent olanzapine has greater affinity for 5-HT2A serotonin receptors than for D2 dopamine receptors and has shown further effectiveness in emetic control when added to the above agents in patients at high risk of CINV. Owing to the effect of inflammation on the risk and severity of CINV, dexamethasone is frequently added to antiemetics across virtually all levels of risk 140 .…”

The Cancer Genomic Integration Model for Symptom Science (CGIMSS): A Biopsychosocial Framework

“…Given that the gut microbiome is thought to be central in gut-brain communication, especially through the production of mood-regulating neurotransmitter serotonin (Margolis et al, 2021), it is logical to theorize that changes in gut microbiota could affect symptoms such as depression and anxiety. Gut microbiome changes may also implicate additional symptoms, such as nausea and other gastrointestinal symptoms (Crowder et al, 2022). Chronic stress can lead to HPA axis perturbations that are known to increase expression of downstream oncogenes (Cui et al, 2021).…”