Identifying predictive factors of chemotherapy-induced nausea and vomiting (CINV): a novel approach

In this issue of Annals of Oncology, Dranitsaris et al. [1] report the development of an innovative prediction tool to identify cancer patients who are at high risk of chemotherapy-induced emesis. This novel approach could possibly change routine daily practice for these patients. International leaders in the field have combined their experience to conduct a study with the aim of identifying predictive factors of chemotherapy-induced nausea and vomiting (CINV), using data prospectively collected from five non-industrial studies [2–8]. The primary endpoint was to detect risk factors related to grade ≥2 CINV, based on previous studies reported in the literature [3, 4, 9, 10]. In the data pooled from 1198 patients who were assessed, the eight predictive factors defined with a P-value set at <0.05 were: patient age ≤60 years, the first two cycles of chemotherapy, anticipatory nausea and vomiting, history of morning sickness, <7 h of sleep the night before, type of chemotherapy, occurrence of CINV during the prior cycle, patient self-medication at home with non-prescribed treatments, and the use of platinum or anthracycline-based regimens. The rigorous methodology developed by the authors to identify these risk factors, met some bias related to preselected measurable variables. The suggested cut-off point at ≥16 had a good sensitivity of 87.4% but a poor specificity at 38.4% with a high rate of false positives. The patient's distribution showed predominantly female gender (74.6%), known to be at higher risk of emesis, as well as a majority of patients undergoing a High Emetogenic Chemotherapy (HEC) regimen, as defined by the different published guidelines [11–13]. Finally, the high level of missing anxiety questionnaire (25.7%) may have impacted the characteristics of defined risk factors.

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