Prevention and control of anticipatory vomiting The optimal antiemetic treatment regimen during each cycle of chemotherapy is key to preventing anticipatory vomiting. Behavioral treatments include relaxation therapy, systematic desensitization, hypnosis, reverie, music therapy, acupuncture and acupressure. In terms of pharmacological treatment, oral alprazolam starting 1 night before treatment or oral lorazepam 1 night before and the morning of treatment is currently recommended. Treatment of fulminant CINV For fulminant CINV, prevention is more important and easier than treatment. The general principle of management is to combine other effective antiemetic drugs with different mechanisms of action, including antipsychotics, benzodiazepines, cannabinoids, dopamine receptor antagonists, phenothiazines, 5-HT3 receptor antagonists, and steroids, with no superiority or inferiority among the various types of drugs. Treatment of fulminant CINV emphasizes on-time dosing rather than on-demand dosing. If nausea and vomiting are controlled, treatment continues with the original regimen, and vice versa with a higher level of antiemetic therapy. If the patient vomits too frequently to take oral medication, rectal or intravenous administration is more appropriate, and adequate fluid intake must be ensured to prevent electrolyte disturbances. The efficacy of the current antiemetic regimen should be re-evaluated before the next cycle of chemotherapy, and if it is not effective, the antiemetic should be changed. In addition, various non-chemotherapy factors associated with fulminant CINV, such as brain metastasis, electrolyte disturbance, intestinal tumor infiltration or abnormal gastrointestinal function, should be noted. When antiemetic therapy is not effective, the following measures are recommended: (1) add aripitant to previous antiemetic use; (2) combine with other antiemetic drugs; (3) adjust the intensity or frequency of 5-HT3 receptor antagonists or switch to other similar drugs; (4) if the patient is receiving palliative chemotherapy, consider using other chemotherapy regimens with similar efficacy and less risk of emesis; (5) combine antiemetic drugs with anxiolytic drugs. (5) Combination of anti-anxiety drugs with antiemetic drugs. Guidelines for the prevention and treatment of radiation-induced nausea and vomiting (RINV) The key to preventing radiation-induced nausea and vomiting (RINV) is the site of radiation therapy and whether it is combined with chemotherapy; for the combination of radiation and chemotherapy, refer to the guidelines for the prevention and treatment of CINV. For those who receive upper abdominal or systemic radiotherapy, daily oral ondansetron or granisetron and, if necessary, oral dexamethasone are recommended; prophylaxis is not recommended for radiotherapy at other sites. For those who develop explosive vomiting, daily oral ondansetron is recommended. Treatment principles for management of multi-day chemotherapy vomiting Patients receiving multi-day chemotherapy are at risk for both acute and delayed vomiting, with emesis related to the chemotherapeutic agent and its sequence of administration. After the first day of chemotherapy, acute and delayed emesis will overlap, and treatment of delayed emesis must be tailored to the severity of emesis from the previous cycle of chemotherapy. For those receiving chemotherapy with moderate-to-high risk of emesis, a 5-HT3 receptor antagonist is recommended first before each day of chemotherapy and dexamethasone once daily; for those receiving chemotherapy with a higher risk of delayed emesis, dexamethasone should be administered for 2 to 3 days after the end of chemotherapy. If the chemotherapy regimen already contains glucocorticoids, the addition of dexamethasone is not recommended. The use of palonosetron avoids the previous cumbersome use of first-generation 5-HT3 receptor antagonists that had to be administered daily in multi-day chemotherapy. Arepitant is recommended for multi-day chemotherapy with a high risk of emetogenic or delayed vomiting, and may be used in combination with a 5-HT3 receptor antagonist and dexamethasone.