Explain how CINV is classified and the mechanism of CINV

There are five categories of CINV: acute, delayed, anticipatory, breakthrough, and refractory.

1. Acute CINV is nausea and vomiting that occurs within 24 hours after the administration of
chemotherapy.
2. Delayed CINV is nausea and vomiting that begins more than 24 hours after chemotherapy
administration.
3. Anticipatory CINV is an emesis that occurs during previous chemotherapy and predisposes to
the risk of developing ANV (Anticipatory Nausea and Vomiting).
4. Breakthrough CINV is an emesis that occurs despite prophylactic antiemetic administration and
requires the use of rescue antiemetics.
5. Refractory CINV responds poorly to multiple antiemetic regimens (Dipiro et al., 2011).

Chemotherapy-induced nausea and vomiting (CINV) occur because cytostatics can affect the
function of neuroanatomy, neurotransmitters, and receptors in the vomiting center (VC). The
neurotransmitters that play a role in CINV are serotonin or 5-hydroxytryptamine (5-HT), substance P
(SP), and dopamine. Cytostatica is toxic which causes enterochromaffin cells to release serotonin in large
quantities. Serotonin then binds to 5-HT3 receptors resulting in a vomiting response in acute CINV. The
release of substance P stimulated by cytostatics will bind to the NK-1 receptor and signal the vagus
nerve afferent fibers to be forwarded to the CTZ and VC. Substance P stimulation of the vagus nerve
causes CINV. The release of dopamine also plays a role in the process of nausea and vomiting (Shinta &
Surarso, 2016).