CHEMOTHERAPY-INDUCED NAUSEA AND VOMITING: RISK STRATIFICATION, CURRENT MANAGEMENT, AND ADJUNCTIVE THERAPIES - NARRATIVE REVIEW

Abstract

Background Chemotherapy induced nausea and vomiting remain among the most common adverse effects of anticancer treatment, affecting up to 80% of patients. Despite effective antiemetic prophylaxis, complete symptom control is not consistently achieved, particularly for nausea and delayed CINV. These symptoms impair quality of life and may negatively affect treatment adherence. Aim This narrative review aims to present the risk factors for CINV and discuss current preventive and therapeutic strategies, with particular emphasis on pharmacological optimization and adjunctive approaches. Materials and Methods A narrative literature review was conducted using PubMed and Google Scholar. The primary search included English language publications on CINV published between 20 April 2016 and 20 April 2026. Earlier key publications were included when they provided relevant information on pathogenesis, risk factors, or therapeutic strategies. A total of 46 publications were included. Results The risk of CINV is influenced by patient related and treatment related factors, supporting individualized risk assessment and preventive strategies. Current guidelines recommend antiemetic regimens according to the emetogenic potential of chemotherapy. Studies of reduced dose olanzapine and alternative agents such as mirtazapine suggest that selected strategies may improve tolerability in specific patient groups. Dietary and non-pharmacological interventions have also been evaluated, but their results remain inconsistent. Conclusions Management of CINV should combine assessment of individual risk with guideline based pharmacological prophylaxis. Selected dose modifications, alternative agents, and adjunctive interventions may be considered in appropriate patients, but further comparative studies are required before these approaches can be routinely recommended.