Grant: Fellowship - PA: Clinical Research

Part 1) Radiation-induced nausea and vomiting (RINV) are distressing, common, and generally under-treated side effects that occur in an estimated 40-80% of patients undergoing radiotherapy. They can detract from quality of life and lead to costly treatment cancellation. Although guidelines exist to prevent RINV, they are not generally followed, and patterns of practice for the management of RINV vary widely. Research into RINV lags terribly behind research into chemotherapy-induced nausea and vomiting (CINV), despite the significant proportion of patients who receive radiotherapy alone at various stages of their disease course. We will assemble a group of international experts from 16 countries to design a web-based survey that will be distributed to all radiation oncologists in those countries to document the current strategies (or lack of strategies) for treating, or more optimistically, preventing RINV. Results will be distributed through publications which will show the level of correlation of current practice with established guidelines, help to explain why RINV is under-treated, and lead to changes in patterns of care. Part 2) 5-HT3 receptor antagonists (5-HT3 RAs) such as Granisetron are one of the most common agents recommended for the prevention of RINV. NK-1 receptor antagonists (NK1 RAs)such as Aprepitant are a new class of agents that decrease rates of nausea and vomiting in patients receiving chemotherapy when they are added to 5-HT3 RAs. The mechanisms underlying RINV and CINV are presumed to be similar; however, there is very limited data on the use of NK1 RAs in studies of radiotherapy. We will conduct a pilot study investigating the combined use of Granisetron and Aprepitant for the prevention of RINV in a group of patients undergoing palliative radiotherapy, which because of the area being irradiated, is likely to induce RINV. We hope that this combination of medications will be safe and effective, and lead to low rates of RINV.