Vomiting during lung cancer treatment: what to expect and how to manage it

Vomiting (often with nausea) can happen with several lung cancer treatments, especially chemotherapy, and sometimes with targeted therapies; immunotherapy tends to cause nausea less often, but it can still occur. ^[1] Nausea and vomiting are specifically reported with commonly used regimens such as carboplatin/etoposide and with oral targeted drugs like crizotinib and osimertinib. ^{[2] [3] [4]} Your team usually prevents these symptoms with anti‑nausea medicines and gives you practical steps to reduce discomfort. ^[1]

Why vomiting happens

• Chemotherapy effect: Agents such as cisplatin and carboplatin can strongly trigger the brain’s vomiting center and the gut’s serotonin pathways, leading to acute (first 24 hours) and delayed (days 2–5) nausea/vomiting. ^[5] Guidelines classify drugs by emetogenic risk to guide prevention. ^[6]
• Targeted therapies: ALK/EGFR inhibitors (for example, crizotinib, lorlatinib, osimertinib) frequently list nausea and vomiting; symptoms may start within hours to days of dosing. ^{[3] [7] [4]}
• Immunotherapy: Checkpoint inhibitors like durvalumab or nivolumab may cause nausea, usually milder; however, other immune‑related adverse events (for example endocrine problems) can indirectly cause nausea and vomiting. ^{[8] [9]}

How common is it?

• Chemotherapy: Without preventive medicines, moderate‑to‑high emetogenic regimens cause vomiting in a substantial proportion of people; cisplatin is classified as high risk (>90% risk), and carboplatin is moderate risk (30–90%). ^{[5] [6]}
• Oral targeted drugs: Patient information sheets for crizotinib, osimertinib, and lorlatinib list nausea/vomiting as common immediate side effects. ^{[3] [4] [7]}
• Immunotherapy: Nausea/vomiting can occur but is often less frequent and milder compared with chemotherapy; anti‑sickness medication may be needed only in some people. ^[9]

Evidence‑based prevention and treatment

Clinical guidelines recommend tailoring antiemetic prophylaxis to the regimen’s emetogenic risk:

• High‑risk chemotherapy (e.g., cisplatin): Use a combination of a 5‑HT3 receptor antagonist, dexamethasone, and an NK1 receptor antagonist to prevent acute and delayed vomiting. [PM18]
• Moderate‑risk chemotherapy (e.g., carboplatin‑based): Preferentially use palonosetron (a 5‑HT3 antagonist) plus dexamethasone; adding an NK1 antagonist can improve delayed control. [PM18] [PM19]
• Low‑risk chemotherapy: A single agent such as dexamethasone or a 5‑HT3 antagonist is often sufficient. ^[10]
• Oral targeted therapies: Routine steroid use is avoided for continuous oral agents; non‑steroidal antiemetics (5‑HT3 antagonists or dopamine antagonists) and individualized strategies are used. ^{[11] [12]}

Despite modern prevention, delayed nausea can still occur; adding an NK1 antagonist improves control, especially after day 1. [PM19]

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Practical self‑care tips

• Take anti‑nausea medicine exactly as prescribed, even if you feel okay. Preventive dosing works better than “as needed.” ^{[13] [2]}
• Hydration and small meals: Sip fluids regularly and choose bland, easy foods (toast, crackers), more often in small portions. ^{[13] [2]}
• Gentle activity: Light movement can ease nausea for some people. ^[13]
• Trigger management: Avoid strong smells and greasy or spicy foods if they worsen symptoms. ^[14]

If you still vomit repeatedly or cannot keep fluids down, contact your care team promptly; uncontrolled vomiting can lead to dehydration and electrolyte problems and may signal another issue that needs attention. ^[15]

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Special considerations with immunotherapy and targeted therapy

• Immunotherapy: While routine antiemetics may not be necessary, report persistent nausea because endocrine issues (like adrenal or thyroid dysfunction) can occur and may require specific treatment. ^[9]
• Targeted therapy: If nausea is ongoing, dosing adjustments or supportive medicines can be considered; immediate onset within hours to days is common with some agents. ^{[3] [7]}

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Summary table: emetogenic risk and typical prevention

Treatment type	Typical emetogenic risk	Recommended prevention
Cisplatin-based chemo	High (>90%)	5‑HT3 antagonist + dexamethasone + NK1 antagonist (consider olanzapine per local practice) [PM18]
Carboplatin-based chemo	Moderate (30–90%)	Palonosetron + dexamethasone; consider adding NK1 antagonist for delayed control [PM18] [PM19]
Low‑risk IV agents	Low (10–30%)	Single agent (dexamethasone or 5‑HT3 antagonist or metoclopramide) [10]
Continuous oral targeted therapy	Variable; often minimal–moderate	Non‑steroidal antiemetics; individualized plan; avoid routine steroids [11] [12]

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When to seek urgent help

• Vomiting persists more than 24 hours despite medicines, or you cannot keep liquids down. ^[15]
• Signs of dehydration (very dry mouth, dizziness, reduced urination). ^[15]
• New symptoms such as severe headache, abdominal pain, fever, or confusion. ^[15]
• On immunotherapy, any persistent nausea with fatigue or dizziness, which could suggest endocrine problems needing evaluation. ^[9]

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Key takeaways

• Vomiting is a well‑recognized side effect of many lung cancer treatments, especially chemotherapy; targeted therapies can also cause it, while immunotherapy usually causes milder nausea. ^{[1] [3] [4] [9]}
• Preventive antiemetic regimens tailored to the treatment’s emetogenic risk are the cornerstone of control, and adding NK1 agents improves delayed symptoms. [PM18] [PM19]
• Practical measures and early communication with your team help keep you comfortable and safe. ^{[13] [2] [15]}