Evidence for a Re-Evaluation of the Neurochemical and Anatomical Bases of Chemotherapy-Induced Vomiting

Evidence for a re-evaluation of the neurochemical and anatomical bases of chemotherapy-induced vomiting is discussed. Emetic signaling is initiated in the gastrointestinal tract in chemotherapy-induced vomiting and many other forms of vomiting. Cancer patients receiving chemotherapy experience not only emesis but also nausea, which is a continuous feeling of gastric discomfort, rather than the episodic discomfort of vomiting. However, salivation, chewing, and retching behaviors are usually considered part of the prodromal phase run by the motor program in the emetic circuitry, and may not be related to nauseous circuits. A 5-HT3 antagonist and dexamethasone, culminates in efficacy against nausea reported in chemotherapy. More comprehensive multineurotransmitter turnover measurements in patients could be made, which would lead to utilization of more broad-spectrum antiemetic regimens for the prevention of chemotherapy-induced vomiting in the clinic.