Guidelines for Complications of Cancer Treatment Vol VIII Part B

2. Delayed CINV: Nausea and vomiting occurring morethan 24 hours after chemotherapy administration. Unlikeacute CINV, delayed vomiting is due to substance Pdependent pathways i.e. through Nk1 receptors.3. Anticipatory CINV: Nausea and vomiting that occursas a result of a conditioned response to prior episodesof CINV. It is a classically conditioned response tostimuli such as smell, sight of chemotherapy room andthought of previous CINV. It depends on many variablessuch as young age, female sex, state of anxiety and degreeof motion sickness.4. Breakthrough CINV: Nausea and vomiting thathappens inspite of optimal preventive treatment. It isusually due to inadequate prophylaxis.5. Refractory CINV: Nausea and vomiting that recurs insubsequent cycles of therapy in spite of all previouspreventive and rescue treatments. It is due to inadequateprophylaxis, inadequate treatment and use of highlyemetogenic regimens.Emetogenic Levels of IntravenouslyAdministered Antineoplastic AgentsThe recent clinical practice guidelines make antiemeticrecommendations based on the risk categories. Both theAmerican Society of Clinical Oncology (ASCO) and theMultinational Association of Supportive Care in Cancer(MASCC) classify chemotherapy induced nausea & vomitingas high (> 90%), moderate (> 30% to 90%), low (10% to 30%),and minimal (< 10%) emetic risk.394