Chemotherapy-induced nausea and vomiting (CINV) is of great clinical concern as it seriously affects compliance with oncology treatment and the quality of patient survival. In this article, Medical Pulse will briefly introduce the hazards and risk factors of CINV, CINV treatment, and CINV guidelines. CINV hazards and risk factors The emergence of CINV during the treatment of tumor patients seriously affects the quality of life of patients and significantly reduces their compliance with treatment. At the same time, CINV can increase the psychological burden of family members, increase nursing workload, and increase the financial burden of patients’ families. In a randomized clinical study, 52 breast cancer patients were randomly divided into two groups and treated with standard dose and low dose chemotherapy drugs to observe the occurrence of anticipatory vomiting and chemotherapy-induced vomiting. The results showed that 19% of the patients discontinued further treatment due to vomiting, and 70% of these patients were treated with standard doses. In addition, foreign studies found that patients without CINV had a significantly higher quality of life than patients presenting with CINV, especially after chemotherapy, with a difference in scores between the two groups. In view of the serious dangers of CINV, it should be given high priority in clinical work. Risk factors for CINV include: patient characteristics, such as patient gender, age, history of alcohol intake, physical status, underlying disease, and control of emesis from previous chemotherapy; chemotherapeutic drug factors, such as dose intensity, dose density, infusion rate, and emesis-causing grading of chemotherapeutic drugs. Once CINV appears, it is difficult to be controlled by drugs, so the key to CINV treatment is prevention rather than treatment. A large number of studies have confirmed that prophylactic application of antiemetic drugs (e.g., aripitant) before oncology chemotherapy can significantly reduce the occurrence of CINV. In comparison, patients who fail to administer emesis prophylaxis prior to chemotherapy are significantly more likely to experience anticipatory emesis, which has a significant negative impact on treatment compliance and patient status. Therefore, before starting oncology-related treatment, the risk of vomiting should be fully assessed, an individualized vomiting prevention and treatment plan should be developed, and preventive antiemetic treatment should be given before chemotherapy. After the final dose of chemotherapy, patients receiving chemotherapy with high and moderate emetic risk drugs are still at risk of nausea and vomiting for at least 2-3 days and therefore need to be protected against vomiting throughout the risk period. Commonly used antiemetic drugs include 5-hydroxytryptamine 3 (5-HT3) receptor antagonists, neuropeptide 1 (NK-1) receptor antagonists, dopamine receptor blockers, adrenocorticosteroids, phenothiazines, and psychotropic antiemetics. The newest anti-emetic drug on the market, aripitant, is the first NK-1 receptor antagonist with a novel pharmacological mechanism of action. It has good permeability to the blood-brain barrier and selectively binds to NK-1 receptors, but has little binding to NK-2 and NK-3 receptors; moreover, it has high affinity for NK-1 receptors and can maintain prolonged central activity, so it can significantly inhibit the occurrence of acute and delayed vomiting. Arepitant has been recommended by several domestic and international guidelines for the prophylactic use of CINV. With the introduction of the NK-1 receptor inhibitor aripitant in China, the control of acute and delayed vomiting has been significantly improved in clinical practice. Previously, 5-HT3 receptor antagonists, an effective agent in chemotherapy regimens for the prevention of moderate and high emesis risk, were effective in controlling acute CINV (because the main neurotransmitter triggering CINV in early stages is 5-HT), but they were less effective in the prevention of delayed CINV. In contrast, aripitant can control CINV throughout the whole process, and its effect is very outstanding. Currently, there are many domestic and international guidelines related to antiemetic treatment, such as the Chinese guidelines for the prevention and treatment of vomiting associated with oncology treatment (2014 edition), the National Comprehensive Cancer Network (NCCN) guidelines (2014 edition), the European Society of Medical Oncology (ESMO)/Multinational Association for Supportive Care of Cancer (MASCC) guidelines (2013 edition) and the American Society of Clinical Oncology (ASCO) guidelines ( These guidelines are excellent tools for guiding clinical care and are clinically effective in significantly increasing the rate of complete control and remission of CINV and bringing improvements in patients’ quality of life. The results of the PEER clinical study showed that the complete remission rate of CINV in patients who followed the guidelines was 60%, while the rate in patients who did not follow the guidelines decreased to 50.7%, with a significant difference between the two groups (p=0.008). According to the guidelines, CINV should be managed before, during and after chemotherapy, such as before chemotherapy, assessing the risk of CINV and the chance of anticipatory vomiting; during chemotherapy, giving different antiemetic regimens according to the risk of emesis, recording nausea and vomiting in detail, and giving rescue antiemetic regimens if vomiting still occurs on the basis of preventive antiemetic regimens; after chemotherapy, paying attention to delayed nausea and vomiting After chemotherapy, pay attention to delayed nausea and vomiting. If patients need to continue antiemetic 2-3 days after chemotherapy and vomiting still occurs on the basis of prophylactic antiemetic regimen, then give relief antiemetic regimen.