Radiation-induced nausea and vomiting (RINV) is common occurrence in cancer patients treated with radiotherapy. The emetogenic potential of these radiations depends greatly on the location of the radiation field, the size of the radiation field and the fractionation scheme. It refers to a radiation sickness syndrome, which is characterized by a latent asymptomatic period 1–2 h after treatment. RINV could induce dehydration, malnutrition and electrolyte imbalance, which worsens patient’s quality of life and lead to treatment delays & cancellation.
According to study, “Radiation Induced Nausea and Vomiting (RINV) Global Clinical Trials Review, H1, 2018” some of the major companies that are currently working in the radiation induced nausea and vomiting are Vimta Labs Ltd, Insys Therapeutics Inc, A. MenariniIndustrieFarmaceuticheRiuniteSrl, RedHillBiopharma Ltd, IPCA Laboratories Ltd, Dr. Reddy’s Laboratories Ltd, AurobindoPharma Ltd, APR Applied Pharma Research SA, Altasciences Company Inc, Accutest Research Laboratories (I) Pvt Ltd.
RINV can be defined by two phases of radiotherapy acute phase and delayed phase. The acute phase is defined as the first day of radiotherapy to one day after administration, whereas the delayed phase encompasses days 2–10 after treatment.
The RINV management include to prevent an initial emetic episode from occurring and to manage symptoms once they present as a result of radiotherapy. Some symptoms of RINV are nausea, vomiting, pallor, diaphoresis, salivation, anorexia, headaches, low urine output, dizziness and rapid heart rate. Some other symptoms include specially for the cancer patients such as constipation, bowel obstruction, gastroparesis, malignant ascites, anxiety, fluid & electrolyte imbalances, uraemia, metastases, liver or central nervous system, raised intracranial pressure, peptic ulcer disease, recent or concurrent chemotherapy and vestibular dysfunction. The occurrence of RINV is depending on radiotherapy-related factors such as the site of irradiation, the dosing, fractionation and irradiated volume and radiotherapy techniques.
RINV’s incidence and severity is depending on both treatment factors and patient related factors. Treatment related factors are site & volume of radiation, single & total dose and fractionation schedule whereas patient related factors are gender, age and concurrent or recent chemotherapy factors. The diagnosis of RINV is depend on many factors such as the frequency, intensity, onset & duration of vomiting, history & compliance with antiemetics, concomitant medications (e.g. opioids), hydration status, nutritional intake +/- weight loss, heartburn/dyspepsia, haematemesis and blood test etc.
The three major antiemetic guidelines exist that make RINV management recommendations, which are multinational association for supportive care in cancer (MASCC), American society of clinical oncology (ASCO) and the national comprehensive cancer network (NCCN). These guidelines divide the RINV risk into four categories based upon radiation field: high (risk>90%), moderate (risk 60 to 90%), low (risk 30 to 60%) and minimal (risk <30%). They also suggest strategies for prophylactic and rescue treatment as a function of the anatomic site being irradiated.
It is estimated that the incidence of RINV among patients undergoing radiotherapy is estimated at 50–80% and a small group of interested international investigators are emerging tocoordinate future research goals in RINV. In upcoming years, by raising awareness of RINV as common clinical concerns, and educating patients about their options for prevention, a strong patient interest and advocacy movement is expected to be develop, which will ultimately be the most powerful motivator for progress in this field.
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Ankur Gupta, Head Marketing & Communications