What additional class of drugs is often utilized alongside serotonin 5-HT3 antagonists to manage CINV?

The use of neurokinin-1 antagonists in conjunction with serotonin 5-HT3 antagonists is a well-established practice for managing chemotherapy-induced nausea and vomiting (CINV). Serotonin 5-HT3 antagonists primarily target the serotonin receptors in the gastrointestinal tract and central nervous system, effectively preventing acute nausea and vomiting. However, neurokinin-1 antagonists work through a different mechanism by blocking substance P, a neuropeptide involved in the emetic response.

By combining these two classes of medications, clinicians can achieve broader coverage against both the acute and delayed phases of CINV, leading to improved patient outcomes. Neurokinin-1 antagonists have been shown to be particularly effective in preventing the delayed nausea and vomiting that can occur days after chemotherapy administration, which serotonin 5-HT3 antagonists may not fully address.

In contrast, opioids, while effective for pain management, do not specifically target the pathways involved in nausea and vomiting and can sometimes exacerbate those symptoms. Aromatase inhibitors and monoclonal antibodies are generally used for cancer treatment rather than directly for symptom management related to CINV. Therefore, neurokinin-1 antagonists represent the additional class of drugs that complements serotonin 5-HT