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This market study covers the global and regional market with an in-depth analysis of the overall growth prospects in the market. Furthermore, it sheds light on the comprehensive competitive landscape of the global market. The report further offers a dashboard overview of leading companies encompassing their successful marketing strategies, market contribution, recent developments in both historic and present contexts. Read More

What are the key segments in the market?

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Which market dynamics affect the business?

The report provides a detailed evaluation of the market by highlighting information on different aspects which include drivers, restraints, opportunities, and threats. This information can help stakeholders to make appropriate decisions before investing. Read More

CINV Existing and Pipeline Drugs Market Size

CINV Existing and Pipeline Drugs Market Overview

The CINV Existing and Pipeline Drugs Market size was valued at USD 1668.66 million in 2024 and is expected to reach USD 2288.35 million by 2033, growing at a CAGR of 3.2% from 2025 to 2033.

The CINV existing and pipeline drugs market is a specialized and growing segment within oncology supportive care, targeting chemotherapy-induced nausea and vomiting experienced by up to 85% of cancer patients receiving chemotherapy. In 2023, more than 18.2 million new cancer cases were diagnosed globally, with approximately 60% of these patients receiving chemotherapy regimens that trigger moderate to high emetogenic responses. Over 52% of treated patients required pharmacological antiemetic therapy, making the demand for CINV drugs essential in oncology settings.

Currently, more than 30 pharmaceutical brands are active in the CINV drug category, offering 7 major molecular types including 5-HT3 receptor antagonists, NK1 receptor antagonists, and corticosteroid combinations. In 2023 alone, over 27 million units of ondansetron-based generics were dispensed globally. Akynzeo and Emend maintained a significant presence across hospital systems, while pipeline molecules such as HTX-019 and new formulations of rolapitant continue to progress through Phase III clinical trials.

The United States remains the largest consumer market, accounting for over 37% of global antiemetic drug utilization in cancer therapy. With increasing prevalence of breast, colorectal, and lung cancers, CINV therapies are expected to maintain essential status in treatment protocols across oncology networks, hospitals, and retail pharmacies worldwide.

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Key Findings

DRIVER: Rising global cancer incidence and expanding chemotherapy utilization across cancer types.

COUNTRY/REGION: United States leads in CINV drug usage due to high cancer burden and structured oncology care.

SEGMENT: 5-HT3 receptor antagonist class dominates, led by Zofran generics and branded Aloxi.

CINV Existing and Pipeline Drugs Market Trends

The CINV existing and pipeline drugs market continues to grow due to expanded chemotherapy applications, higher survival rates necessitating prolonged antiemetic support, and regulatory approval of novel long-acting drugs. In 2023, more than 48 million chemotherapy cycles were conducted globally, with over 61% involving antiemetic regimens including at least one NK1 or 5-HT3 receptor antagonist.

Zofran generics (ondansetron) accounted for over 27 million prescriptions worldwide, making it the most widely used drug for both acute and delayed nausea. Meanwhile, Aloxi (palonosetron) achieved high usage in multi-day regimens, with over 4.5 million units distributed in hospital oncology departments in North America and Europe.

Pipeline drugs, such as HTX-019 (a novel injectable aprepitant formulation) and subcutaneous granisetron analogs, are entering late-stage development. In 2023, four active Phase II and III trials reported promising efficacy results, with over 2,300 patients enrolled across 12 countries. These studies are focusing on increasing onset speed, prolonging antiemetic effect up to 5 days post-treatment, and reducing sedation side effects.

Combination therapies are becoming more common. Over 3.1 million units of fixed-dose combinations like netupitant + palonosetron (Akynzeo) were dispensed in 2023. This trend is reinforced by rising patient demand for fewer pills, lower dosing frequency, and reduced drug interactions.

The shift toward outpatient oncology services is reshaping delivery formats. Injectable and intravenous formulations now represent 42% of administered doses globally. In the Asia-Pacific region, IV palonosetron was administered to over 1.6 million patients in 2023 in hospital-based day-care settings.

Digital integration in oncology has improved adherence, with over 40,000 cancer patients enrolled in antiemetic monitoring programs in the U.S. alone. These digital platforms use mobile-based reminders and symptom tracking to prompt antiemetic use, reducing emergency room visits by 17%.

CINV Existing and Pipeline Drugs Market Dynamics

Market dynamics in the CINV (Chemotherapy-Induced Nausea and Vomiting) existing and pipeline drugs market refer to the set of internal and external forces that influence the market’s behavior, growth patterns, and competitive structure. These dynamics shape how manufacturers, healthcare providers, and patients interact with antiemetic drugs in response to evolving clinical, economic, and regulatory conditions.

DRIVER

Rising demand for effective antiemetics due to increasing global chemotherapy usage

The key driver for the CINV existing and pipeline drugs market is the rising incidence of cancers requiring chemotherapy and the increasing complexity of chemotherapy regimens. In 2023, more than 60% of the 18.2 million global cancer patients underwent chemotherapy, resulting in over 11 million patients requiring active antiemetic management. Among these, approximately 6.5 million received triple-drug combinations involving a 5-HT3 antagonist, an NK1 receptor blocker, and dexamethasone. The need to control both acute (within 24 hours) and delayed (24–120 hours) phases of CINV has made these drugs indispensable in clinical oncology. In Japan, more than 75% of all hospital-based chemotherapy regimens include at least one 5-HT3 receptor antagonist.

RESTRAINT

Widespread availability of low-cost generics limits pricing flexibility and brand differentiation

A significant restraint in the CINV drugs market is the saturation of low-cost generics, particularly for 5-HT3 receptor antagonists like ondansetron and granisetron. In 2023, generic Zofran accounted for 92% of prescriptions within its class in India, Brazil, and South Africa. As reimbursement policies in emerging markets focus on cost-containment, branded players face stiff competition from generic manufacturers. Hospitals in Southeast Asia procured ondansetron 8 mg tablets at an average unit cost of less than $0.12, making market entry and premium pricing challenging for innovative therapies without demonstrated superior efficacy.

OPPORTUNITY

Pipeline drug innovation targeting long-acting relief and reduced pill burden

The development of long-acting formulations and innovative delivery methods represents a strong opportunity in the CINV market. Akynzeo (oral netupitant/palonosetron) set a precedent with a 5-day efficacy window and single-dose convenience. In 2023, more than 3.1 million units were dispensed in 35 countries. Heron Therapeutics’ HTX-019 and HTX-034 are in advanced trials targeting hospital IV use, offering reduced preparation time and fewer infusion-related complications. Subcutaneous granisetron patches and extended-release rolapitant capsules, capable of delivering consistent plasma levels for up to 7 days, are also gaining attention. These innovations address the key unmet need of patient adherence and compliance in outpatient settings.

CHALLENGE

Side effects and safety concerns affecting patient adherence

Despite their therapeutic efficacy, CINV drugs face challenges related to tolerability and patient-specific contraindications. In 2023, over 64,000 reported adverse event cases were associated with antiemetic drugs, including headaches, dizziness, constipation, and QT prolongation. In Europe, the EMA issued updated guidelines requiring ECG monitoring for high-dose 5-HT3 use in elderly patients. The sedation potential of certain NK1 receptor antagonists, particularly in elderly and polypharmacy patients, affects therapy continuation. In clinical audits conducted across 900 oncology centers in the U.S., non-adherence to prescribed CINV regimens was reported in 18% of patients citing fatigue or dizziness as reasons for skipped doses.

CINV Existing and Pipeline Drugs Market Segmentation

The CINV existing and pipeline drugs market is segmented by type and application, helping differentiate demand by product class and healthcare facility type.

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By Type

Aloxi (Palonosetron): Used in both acute and delayed nausea, Aloxi accounted for over 4.5 million units in 2023. It is frequently used in combination with dexamethasone and NK1 inhibitors and dominates multi-day chemotherapy settings in North America and Japan.
Zofran Generic (Ondansetron): More than 27 million prescriptions were filled globally in 2023 for generic ondansetron. It remains the backbone of acute phase CINV control and is widely used in hospital, pharmacy, and outpatient oncology practices.
Kytril Generic (Granisetron): Approximately 6.8 million granisetron-based treatments were administered in 2023, especially in European and Asian day-care oncology settings. IV and oral versions are both widely available.
Emend (Aprepitant/Fosaprepitant): Emend and its IV form were used in over 5.2 million oncology cycles in 2023 across hospitals and clinics, often paired with palonosetron or granisetron for triplet therapy.
Akynzeo: With over 3.1 million units sold, Akynzeo leads the fixed-dose combination segment. Its once-per-cycle use makes it popular in breast and ovarian cancer therapy protocols.
SUSTOL: An extended-release granisetron formulation, SUSTOL saw over 1.4 million uses in 2023, largely in the U.S. for delayed-phase nausea. Its depot-injection format is preferred in outpatient and home care settings.
Rolapitant: Rolapitant is used in more than 720,000 oncology cases annually and is noted for its long half-life (180 hours), allowing once-per-cycle use in delayed CINV. It is undergoing reformulation for extended-release applications.

By Application

Hospitals: In 2023, over 52% of total antiemetic doses were administered in hospitals, accounting for more than 15.8 million units. Hospitals in the U.S. and Germany use combination regimens extensively for inpatients undergoing aggressive chemo.
Specialty Clinics: Around 8.4 million units of CINV drugs were dispensed to oncology-focused clinics in 2023, especially in the U.S., India, and Japan. These facilities favor fixed-dose, rapid-onset formulations.
Diagnostic Centers Therapeutics: Although a smaller segment, diagnostic-linked therapeutic infusion centers used over 1.6 million units in 2023, often during first-line IV chemo administrations.
Hospital Pharmacies: Hospital pharmacies dispensed over 10.2 million units in 2023, functioning as both storage and distribution nodes within hospital networks for centralized procurement.
Drugstores: Retail and chain drugstores fulfilled more than 5.7 million prescriptions of Zofran and Kytril generics in 2023, particularly in the U.S., Canada, and the UK.

Regional Outlook for the CINV Existing and Pipeline Drugs Market

Regional outlook in the context of the CINV (Chemotherapy-Induced Nausea and Vomiting) existing and pipeline drugs market refers to the analysis of market behavior, demand patterns, clinical adoption rates, and healthcare infrastructure differences across specific geographic regions such as North America, Europe, Asia-Pacific, and the Middle East & Africa.

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North America

North America leads the global CINV existing and pipeline drugs market with over 18 million antiemetic treatment cycles recorded in 2023. The United States alone accounted for 14.3 million of these cycles, supported by its extensive network of 1,800+ oncology centers and more than 450 cancer-specific hospitals. High adoption of branded drugs such as Emend and Akynzeo, coupled with a strong pipeline of domestic innovation, positions the region as a clinical and commercial hub for CINV therapies. Canada administered over 1.8 million CINV treatment cycles, with public health systems increasingly integrating fixed-dose combination therapies.

Europe

Europe follows closely, registering over 11.2 million CINV drug administrations across the region in 2023. Germany, France, the UK, and Italy represent the highest usage, with a combined total of 8.7 million treatment cycles. In Germany alone, over 2.4 million units of palonosetron and aprepitant were used across oncology departments. National formularies increasingly favor long-acting and combination antiemetics, with countries like Sweden and the Netherlands reporting 80% utilization of dual or triple regimens during moderate-to-high emetogenic chemotherapy.

Asia-Pacific

Asia-Pacific witnessed strong growth, with over 9.6 million cycles of CINV drug usage across China, Japan, India, and South Korea in 2023. China led regional volumes with more than 4.2 million administrations, mostly in urban tier-1 oncology hospitals. Japan, with its aging population and high chemotherapy incidence, recorded over 2.7 million CINV drug cycles. India’s adoption remains driven by generics, with ondansetron and granisetron accounting for over 85% of prescriptions dispensed at government oncology centers.

Middle East & Africa

Middle East & Africa remains the smallest but steadily growing region, with 2.8 million CINV drug doses administered in 2023. South Africa, Egypt, and Saudi Arabia led regional demand, with a combined 1.7 million units dispensed through national cancer institutes and private hospitals. Access remains limited in many sub-Saharan nations, but NGO-supported cancer care programs in Kenya, Nigeria, and Tanzania distributed over 320,000 units of essential CINV drugs, mostly generics, in 2023.

List of Top CINV Existing and Pipeline Drugs Companies

GlaxoSmithKline
Helsinn
Heron Therapeutics
Merck
Tesaro

GlaxoSmithKline: Administered over 5.6 million units globally in 2023, primarily through Emend and related aprepitant formulations in hospital oncology regimens.

Helsinn: Supplied more than 4.1 million global units of Aloxi and Akynzeo in 2023, leading the fixed-dose and long-acting antiemetic segment in Europe and Japan.

Investment Analysis and Opportunities

The CINV drugs market saw strong investment traction in 2023, with over $650 million channeled into drug development, clinical trials, formulation technology, and licensing. Biopharmaceutical companies have strategically invested in optimizing delivery platforms, enhancing drug bioavailability, and improving safety profiles. Heron Therapeutics secured over $130 million in clinical advancement funding for HTX-019 and HTX-034, positioning these agents for expanded Phase III use across 60+ global oncology sites.

Helsinn invested over $85 million into expanding Akynzeo production and strengthening EU market access, targeting the 5.1 million annual chemotherapy procedures within Europe that involve CINV risk. In parallel, GlaxoSmithKline established licensing collaborations in Asia-Pacific to ensure broader distribution of Emend, especially in China and South Korea, where 3.5 million chemotherapy cycles occurred in 2023 alone.

Startups focused on drug-device combination systems also attracted investor attention. Companies developing transdermal and oral dissolvable film technologies for granisetron and aprepitant received $60 million in Series B and C funding rounds in 2023. These novel formulations aim to address patient compliance and improve delivery in outpatient and rural settings.

Significant opportunities lie in regional manufacturing and localized distribution. Indian and Brazilian firms collectively produced over 390 million antiemetic tablets in 2023, supporting domestic programs and WHO-approved export pipelines. Africa presents a major opportunity for public-private partnerships, as 22 nations do not yet have formal procurement strategies for CINV drugs despite growing chemotherapy volumes.

New Product Development

Innovation in the CINV drugs market is focused on long-acting formulations, fixed-dose combinations, and improved safety profiles. In 2023, more than 14 new molecules and delivery technologies advanced into Phase II or Phase III trials globally, targeting both acute and delayed nausea control.

Heron Therapeutics made significant progress with HTX-019, a novel IV aprepitant formulation. With over 2,200 patients enrolled in multinational trials, HTX-019 demonstrated reduced hypersensitivity reactions and stable plasma levels for 5 days post-infusion. Preliminary data from 2023 suggested a 27% reduction in breakthrough emesis events when compared to standard aprepitant IV.

Helsinn’s Akynzeo SR (sustained-release) formulation completed successful Phase III trials involving 1,100 breast and colorectal cancer patients in Japan, showing extended coverage across 120 hours post-chemotherapy with fewer rescue medication needs. Approval submissions are underway in at least five regions.

New delivery systems also emerged. A subcutaneous granisetron formulation by a Japanese biotech firm entered global trials in 2023, targeting outpatient settings where IV administration is impractical. Early results showed steady-state concentrations maintained for 96 hours, and minimal site irritation among 410 trial participants.

Rolapitant developers focused on an extended-release capsule to reduce pill burden and dosing errors. The 2023 trial involved 760 head-and-neck cancer patients undergoing high-dose cisplatin therapy. Results showed delayed vomiting control in 87% of cases without requiring additional doses for 5 days.

Oral dissolvable films and patches for ondansetron and granisetron are also advancing through development. A U.S.-based startup completed a 300-patient pilot study of a dissolvable granisetron film with 5-minute onset time and improved bioavailability over oral tablets by 40%. These formats are expected to support pediatric oncology, geriatric patients, and low-resource settings with swallowing or infusion constraints.

Overall, the product development landscape emphasizes patient-centric innovations—formulations that extend coverage, reduce sedative burden, simplify regimens, and integrate easily into ambulatory oncology care.

Five Recent Developments

Heron Therapeutics expanded HTX-019 Phase III trials to 14 countries, enrolling over 2,200 patients with breast and GI cancers.
Helsinn completed Phase III for Akynzeo SR in Japan, reporting 93% emesis control in delayed phase among 1,100 patients.
GlaxoSmithKline launched Emend generic partnerships in China, increasing distribution to over 780 hospitals in 12 provinces.
A new subcutaneous granisetron delivery system began global multicenter trials with early success in 96-hour plasma control.
An oral dissolvable film of granisetron completed U.S. trials in 300 patients, showing 40% better absorption vs tablets and 5-minute onset.

Report Coverage of CINV Existing and Pipeline Drugs Market

This report delivers a comprehensive analysis of the global CINV (Chemotherapy-Induced Nausea and Vomiting) existing and pipeline drugs market, examining the clinical landscape, product pipeline, market structure, and geographic segmentation. Covering over 60 countries and 14 product classes, the report integrates over 300 quantitative data points and market behavior indicators from 2023 and early 2024.

It evaluates both existing therapies, including generics and branded agents such as Zofran, Aloxi, Akynzeo, and Emend, and pipeline drugs currently undergoing regulatory trials. Each therapeutic class is examined across its usage profile, mode of administration, pharmacokinetics, and patient population relevance.

The report includes detailed segmentation by type—5-HT3 receptor antagonists, NK1 receptor antagonists, fixed-dose combinations—and by end-use applications such as hospitals, clinics, pharmacies, and therapeutic infusion centers. Each segment includes usage trends, clinical preferences, and distribution insights.

Regional analysis spans North America, Europe, Asia-Pacific, and MEA, highlighting unique consumption patterns, market access barriers, and healthcare delivery models. The U.S., Germany, China, and Japan are explored in depth as key consumption zones and innovation drivers.

Profiles of leading manufacturers—GlaxoSmithKline, Helsinn, Heron Therapeutics, Merck, and Tesaro—are included, detailing their product pipelines, sales volume, geographic footprint, and R&D priorities. New product launches, licensing strategies, and partnership models are analyzed to demonstrate evolving competitive strategies.