**7. Conclusions**

CINV represents a common adverse event of chemotherapy with potentially significant negative impact on quality of life for patients and their families. Prevention and management of CINV is crucial to increase patients' compliance and adherence to antitumoral treatments.

#### **7.1 High-risk of emesis**

The combination of a 5-HT3 receptor antagonist, dexamethasone and aprepitant before chemotherapy is currently the recommended strategy for chemotherapy with high- and moderate-risk of emesis. More robust data is available for cisplatinbased chemotherapy and anthracycline plus cyclophosphamide regimen, less robust data is available for other agents. Approximately 90% of patients receiving cisplatin-based chemotherapy and anthracycline plus cyclophosphamide regimen develop delayed emesis. These patients should receive a regimen with one of 5-HT3 receptor antagonists plus 3-days oral aprepitant plus dexamethasone on days 2 to 4 to avoid delayed emesis.

#### **7.2 Moderate-risk of emesis**

For moderate-risk agents different from and anthracycline plus cyclophosphamide regimen, a combination of a 5-HT3 receptor antagonist and dexamethasone should be administered before chemotherapy. Patients with moderate risk of emesis have moderate potential for delayed emesis. These patients should be treated with a 5-HT3 receptor antagonist or dexamethasone alone on days 2 and 3.

#### **7.3 Low-risk of emesis**

For patients receiving chemotherapy with low-risk of emesis, a single dose of dexamethasone or a dopaminergic before chemotherapy is currently recommended. No routine prevention for delayed emesis is recommended.


**Table 5.** *Management of RINV.*

#### **7.4 Minimal-risk of emesis**

No routine prevention for acute and delayed CINV is generally indicated for chemotherapy with minimal-risk of emesis (**Table 5**).

Strategies to prevent and manage CINV represents a major challenge. In the last 20 years, more effective and well-tolerated antiemetic agents have been introduced in the clinical practice. Selective 5-HT3 receptor antagonist, NK1 antagonist receptors and steroids are currently the most effective combination. This antiemetic strategy achieved an excellent control of CINV in over 80% of patients with an excellent side-effect profile. The further goal should be the management of patients with refractory CINV impacting on therapeutic adherence.
