The emetic risk of trastuzumab deruxtecan (T-DXd) is classified as moderate in Japan; however, controlling nausea and vomiting is difficult with doublet therapy comprising a 5-hydroxytryptamine type 3 (5-HT3) receptor antagonist and dexamethasone. We retrospectively evaluated the effect of adding a neurokinin-1 (NK1) receptor antagonist to doublet antiemetic therapy with palonosetron and dexamethasone on T-DXd-induced nausea and vomiting. The patients were divided into those receiving triplet antiemetic therapy containing the NK1 receptor antagonist fosnetupitant (PDN group) and those receiving doublet antiemetic therapy without fosnetupitant (PD group). Adding fosnetupitant increased the complete antiemetic control rate in the PDN group by 34.9% compared with that in the PD group. Triplet antiemetic therapy with palonosetron, dexamethasone, and fosnetupitant may provide effective antiemetic prophylaxis for T-DXd-induced nausea and vo miting.

Drug-induced QTc prolongation has emerged as a major, preventable cause of malignant ventricular arrhythmias in cancer therapy. This narrative review integrates mechanistic, clinical, and practical insights into QTc prolongation associated with antineoplastic and supportive medications. We outline direct ionic mechanisms, most notably hERG/IKr blockade and PI3K/Akt pathway modulation, as well as indirect contributors, including cytokine-mediated myocarditis, electrolyte disturbances, and structural remodeling. High-risk agents, including arsenic trioxide, vandetanib, nilotinib, sunitinib, and ribociclib, are contrasted with lower-risk alternatives and QT-sparing strategies. Polypharmacy and drug-drug interactions are emphasized as major real-world amplifiers of risk. Among supportive medications, fluoroquinolones, azole antifungals, and certain antiemetics frequently interact with QT-active anticancer agents, whereas beta-lactams, echinocandins, isavuconazole, and palonosetron may represent safer alternatives. We propose a mechanism-to-bedside framework that incorporates baseline ECG and electrolyte assessment, QT-risk stratification, and clear intervention thresholds (QTc ≥ 500 ms or an increase of ≥ 60 ms). Acute management of torsades de pointes, including intravenous magnesium and overdrive pacing, as well as structured hold-and-rechallenge algorithms, is also summarized. Finally, we highlight system-level measures, such as drug interaction stewardship, standardized discharge communication, and clinician education, to shift cardio-oncology practice from reactive arrhythmia management toward anticipatory prevention. This integrative synthesis aims to preserve oncologic efficacy while mitigating arrhythmic risk in modern cancer care.

Pain and postoperative nausea and vomiting (PONV) are the most prevalent postoperative complications following orthognathic procedures. Acupuncture therapy is advocated as one of the treatment alternatives for preventing PONV. This trial aims to investigate the efficacy of preoperative intradermal acupuncture in combination with dexamethasone and palonosetron in high-risk patients undergoing bimaxillary orthognathic surgery, employing a multimodal risk-reduction strategy aligned with consensus guidelines.

5-hydroxytryptamine type 3 (5-HT3) receptor antagonists are used to treat nausea and vomiting and in the prevention of chemotherapy-induced, radiation-induced, and postoperative nausea and vomiting. Most of the 5-HT3 receptor antagonists (i.e., ondansetron, tropisetron, dolasetron, palonosetron, and ramosetron) are metabolized by CYP2D6, but the extent of CYP2D6 involvement varies. CYP2D6 genetic variation can influence the metabolism of these medications, particularly ondansetron and tropisetron, thereby affecting drug efficacy. This guideline is an update to the 2016 Clinical Pharmacogenetics Implementation Consortium (CPIC) guideline for CYP2D6 genotype and use of ondansetron and tropisetron and includes updated information on CYP2D6 genetic testing and evidence tables. We summarize evidence from the published literature supporting these associations and provide therapeutic recommendations for 5-HT3 receptor antagonists based on CYP2D6 genotype, particularly where genetic variation is associated with reduced drug efficacy (updates at https://www.clinpgx.org/guideline/PA166251457).

Oxaliplatin is widely used in the treatment of gastric and gastro-oesophageal junction cancer. However, oxaliplatin-induced nausea and vomiting often complicate treatment and negatively affect patients' quality of life. The current standard antiemetic regimen-dexamethasone (DEX) plus palonosetron-offers only limited efficacy, benefiting approximately 70% of patients, and is associated with steroid-related adverse effects, including insomnia and gastrointestinal bleeding. Consequently, there is a clear clinical need for effective DEX-free antiemetic regimens. This study aims to evaluate the efficacy and safety of megestrol acetate versus DEX in preventing oxaliplatin-induced nausea and vomiting in patients with gastric or gastro-oesophageal junction cancer.

Postoperative nausea and vomiting (PONV) remain one of the most distressing and consequential complications in perioperative care, with a particularly high incidence in otologic surgeries, where vomiting can jeopardize graft stability and hearing outcomes. This review provides a focused, evidence-based evaluation of the comparative efficacy of palonosetron-dexamethasone and granisetron-dexamethasone combinations in preventing PONV, integrating pharmacologic insights with procedure-specific clinical implications. Drawing upon studies published between 2015 and 2025, it highlights the superior and sustained efficacy of palonosetron, a second-generation serotonin (5-hydroxytryptamine type 3; 5-HT3) receptor antagonist, due to its longer half-life, allosteric receptor binding, and enhanced pharmacodynamic stability. The synergistic benefit of combining a 5-HT3 receptor antagonist with dexamethasone, a corticosteroid with anti-inflammatory and central inhibitory properties, is emphasized, demonstrating improved control of both early and delayed PONV with minimal adverse effects. Moreover, the review contextualizes these findings within the unique challenges of otologic procedures and discusses their safety, cost-effectiveness, and clinical applicability. By bridging pharmacologic evidence with surgical realities, this review underscores the need for procedure-specific, long-acting antiemetic strategies and advocates for multicentric, cost-conscious research to refine prophylactic protocols. Ultimately, it offers a novel synthesis that advances PONV management in otologic surgery through the integration of clinical efficacy, patient safety, and economic prudence. The evidence supports palonosetron-dexamethasone as the more effective and sustained prophylactic regimen compared with granisetron-dexamethasone, particularly for delayed PONV (6-48 h) in otologic surgeries. Palonosetron-based dual therapy should be preferred in high-risk middle ear procedures where postoperative vomiting may compromise graft integrity, while granisetron-dexamethasone remains a reasonable lower-cost option for shorter or lower-risk cases.

High-dose melphalan (HDM) is the standard conditioning regimen before autologous stem cell transplantation (ASCT) in plasma cell malignancies. Despite prophylactic antiemetics, chemotherapy-induced nausea and vomiting (CINV) remains a prevalent challenge. We retrospectively compared the efficacy of netupitant and palonosetron (NEPA) plus dexamethasone with that of serotonin receptor antagonist (5-HT3RA)-based regimens (the control group) for patients receiving HDM. The primary endpoint was complete resolution (CR) of CINV in the acute (0-24 hours) and delayed (24-168 hours) phases. Secondary endpoints included overall response rate (ORR), subgroup benefit, and nutritional outcomes. In total, 108 patients were included (NEPA, n = 38; control, n = 70). The NEPA group exhibited higher CR rates in both acute (65.8% vs 32.9%; p < 0.010) and delayed phases (50.0% vs 12.9%; p < 0.010). NEPA achieved a higher ORR (73.7% vs 24.3%; p < 0.010). Subgroup analysis indicated consistent benefits across most clinical strata. Multivariable analysis identified NEPA and male gender as independent factors predicting CR. The median duration of parenteral nutrition (PN) was shorter in the NEPA group than in the control group (median, 2 days [range 1-2] vs 3 days [range, 3-5.75]; p = 0.046). Compared to standard 5-HT3RA regimens, NEPA significantly improved antiemetic efficacy in patients undergoing HDM conditioning.