CHEMOTHERAPY-INDUCED NAUSEA AND VOMITING (CINV): EFFICACY OF DIFFERENT ANTIEMETIC REGIMENS ACROSS EMETOGENIC RISK LEVELS

ABSTRACT OBJECTIVES This audit aimed to determine the efficacy of different antiemetic regimens across emetogenic risk levels in managing chemotherapy-induced vomiting and nausea. METHODOLOGY This retrospective cross-sectional clinical audit was conducted at the Department of Oncology, Northwest General Hospital, Peshawar, from Jan to December 2024, involving 369 patients presenting for chemotherapy. Patients' demographic and clinical characteristics were collected from medical records or directly from patients regarding their last chemotherapy experience. Patients were receiving three antiemetic regimens: Triplet antiemetic regimen (Aprepitant + Ondansetron + Dexamethasone), Triplet regimen + Metoclopramide, and Triplet regimen + domperidone. The incidence of vomiting and nausea post-chemotherapy was assessed using a structured questionnaire. SPSS-25 was used for data analysis. The chi-square test was applied with a 5% significance level. RESULTS Out of 369 cancer patients receiving chemotherapy, the median age was 54 years (IQR=18), ranging from 14 to 87 years, with a majority being female 209(56.6%). Vomiting was reported in 57(15.4%) patients, primarily occurring within the first three days, 33(58%), peaking on day two. Most cases were mild (1-2 episodes/day) in 39(68%) patients, with severe vomiting (≥10 episodes/day) occurring in only 3(5.3%) patients. Nausea was reported by 111(30.1%) patients. Digestive system cancers 81(22%) and breast cancer 78(21.1%) were the most common cancer types. Vomiting was significantly associated with moderate-risk chemotherapy (p<0.0001), where the triplet + metoclopramide group had the highest incidence. (29/42 cases)(69%). Overall, patients in the triplet + domperidone group had a lower incidence of nausea (49/111)(44%) and vomiting (22/57)(38.6%) compared to the triplet + metoclopramide group, though differences were not always statistically significant (p=0.17 for vomiting, p = 0.008 for nausea). Vomiting was significantly associated with antiemetic regimen selection in digestive system cancers (p<0.0001) and blood cancers (p=0.032), whereas nausea was significantly associated with antiemetic regimen selection in digestive system cancers (p<0.0001). CONCLUSION The triplet + domperidone regimen was associated with lower observed rates of chemotherapy-induced nausea and vomiting. However, overall differences between regimens were not statistically significant (except in the moderate emetogenic risk group), suggesting that the treatments were generally comparable in effectiveness