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Introduction
During the lifetime of many of healthcare professionals reading this article, the way in which chemotherapy induced nausea and vomiting (CINV) is approached and treated has transformed. The three papers reporting phase 2 and 3 dose-finding, efficacy and safety studies of an oral fixed-dose combination (netupitant and palonosetron, NEPA) of a tachykinin NK1 receptor [substance P (SP)] antagonist (NK1 RA, netupitant, 300 mg) and a 5-hydroxytryptamine 3 receptor antagonist [5-HT3 RA, palonosetron (PALO), 0.5 mg] are the latest clinical developments in the search for optimal anti-emetic therapy. This shift in approach to CINV is multifactorial: (i) a change in the attitude of healthcare professionals to nausea and vomiting, now viewed as something to be treated rather than tolerated by the patient; (ii) identification of risk factors initially: age, sex, alcohol consumption and emetic history, but screening for polymorphisms that may influence efficacy of 5-HT3 RA (e.g. ABCB1,) could be included; (iii) anti-emetic guidelines; (iv) the introduction of the highly emetic cisplatin in the 1980s stimulated research into anti-emetics; (v) the recognition of anticipatory, acute and delayed phases of CINV and insights into their differing mechanisms and pharmacology; (vi) a shift in the way that identification of novel anti-emetics was approached by using models such as the ferret in which emesis was induced by cisplatin and which led to identification of the involvement of 5-HT3 and NK1 receptors. Research into the involvement of 5-HT3 and NK1 receptors continues.
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