The Evolution of Supportive Therapy of Emesis

Author: Rodger J. Winn MD
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It is axiomatic that state-of-the art antineoplastic therapy calls for a multi-pronged strategy with an emphasis on integrating complementary and, hopefully, synergistic modalities. With the advent of more-precise molecular and genetic typing and the identification of responsive and resistant subgroups, this therapy is also becoming more customized; one size no longer fits all. The net result of this heterogeneous approach is a greater burden on the oncologist caregiver. The field has progressed far beyond the cookbook stage, when once we knew the tumor type, the treatment choice flowed somewhat automatically. What is not so readily apparent, however, is that this complexity of management decisions also extends to the use of supportive care agents. In the not too distant past, the practicing oncologist had only a limited repertoire of interventions to manage such incapacitating and even limiting events as intractable chemotherapy-induced vomiting, but today a much broader array of interventions is available. This array of treatment options, in turn, has led to the increasing need to characterize the clinical aspects of the syndromes, to apply individualized treatments. The science of emesis continues to evolve. Introduction of the 5-HT3 receptor inhibitors were a significant advance in managing the acute vomiting that follows closely after the administration of highly emetogenic agents, but control was certainly not complete. Two articles in this issue address the further refinements in the management of post-chemotherapy vomiting. Stoutenberg and Raftopoulos review the physiology and clinical effectiveness of a new class of antiemetic agents, the NK1 receptor antagonists, as...

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Rodger J. Winn is the Editor-in-Chief of JNCCN. His past positions include Associate Professor of Clinical Medicine at the University of Texas M. D. Anderson Cancer Center. Dr. Winn received his medical degree from Jefferson Medical College of Philadelphia. His postgraduate training includes an internship and residency at Jefferson Medical College, and he also completed a medical oncology fellowship at Memorial Sloan-Kettering Cancer Center in New York. He is board certified in internal medicine and holds subspecialty certification in oncology.

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