Possible role of aprepitant for intractable nausea and vomiting following whole brain radiotherapy—a case report

Nausea and vomiting are most distressing and debilitating symptoms encountered in cancer patients with intracranial metastasis or due to complications of cancer treatment. The overall incidence of radiation induced nausea and vomiting (RINV) is 28 percent in patients receiving different kinds of radiotherapy without concurrent chemotherapy (1). In addition to decreasing compliance of ongoing treatment, it results in dehydration, electrolyte imbalances and malnutrition leading to decreased quality of life (QOL) (2-4). Because of increased incidence of nausea and vomiting after whole brain radiotherapy (WBRT), different antiemetic agents had been tried with mixed results (5). Newer agents like aprepitant, a substance P neurokinin 1 receptor antagonist which is approved for prevention of chemotherapy induced nausea and vomiting (CINV), may have a role in the management of radiotherapy induced nausea and vomiting considering the fact that there is a similarity between the underlying mechanism of CINV and nausea and vomiting after WBRT (6,7). As in CINV, the best understood mechanism of RINV is chemoreceptor trigger zone (CTZ)/area postrema (AP) stimulation (direct or indirect); stimulation of gastrointestinal (GI) mucosal nerves, neurotransmitter release, direct or indirect stimulation of various “pro-emetic” receptors; cortical or vestibular mechanisms: altered smell/taste; and/or release of emetic mediators from the tumour area (6,7)