Adding aprepitant to other antiemetics further prevents chemo-induced nausea and vomiting

Reuters Health - 19/04/2021 - Adding aprepitant to palonosetron and dexamethasone can further prevent nausea and vomiting caused by moderately emetogenic FOLFIRI and FOLFOX chemotherapy in women with gastrointestinal cancer, a new study indicates.

Aprepitant is a neurokinin-1 (NK-1) receptor antagonist (RA) with a different mechanism of action from that of palonosetron, a highly effective 5-HT3 RA and other antiemetics used to prevent chemotherapy-induced nausea and vomiting (CINV).

"It remains controversial whether an NK-1 RA-containing prophylactic regimen should be used in moderately emetogenic chemotherapy of various types of cancers," researchers explain in JAMA Network Open.

To investigate, they focused on patients with higher risk factors for CINV, namely, younger women with little or no history of alcohol use, undergoing FOLFIRI (fluorouracil, leucovorin, and irinotecan) or FOLFOX (fluorouracil, leucovorin, and oxaliplatin) chemotherapy for GI cancer.

Patients received oral aprepitant or placebo (125 mg one hour before initiation of chemotherapy on day 1, and 80 mg each morning of days 2 and 3). Both groups received palonosetron (0.25 mg given intravenously) and oral dexamethasone (6 mg in the aprepitant regimen and 12 mg in the placebo regimen) 30 minutes before chemotherapy initiation on day one.

Of 248 women enrolled at four centers in China, 243 were evaluable for efficacy and safety - 125 in the aprepitant group and 118 in the placebo group.

The proportion of patients without emesis episodes or need for rescue medication was significantly higher in the aprepitant group compared with the placebo group in the overall phase of the first chemotherapy cycle (0 to 120 hours; 87% vs. 67%; P<0.001) and in the acute (0 to 24 hours: 93% vs. 76%, P=0.001) and the delayed (24 to 120 hours: 89% vs. 70%; P=0.001) phases.

"Aprepitant also had an important role in improving protection against nausea. In the overall phase, the incidence of CINV per day in the aprepitant group remained lower than in the placebo group," report Dr. Yu-Hong Li of the State Key Laboratory of Oncology in South China, in Guangzhou, and colleagues.

"Increases were seen in the proportion of no nausea (16.7%) and no substantial nausea (5.9%). In addition, the reduction in the incidence of CINV improved the patients' quality of life. The proportions of a detrimental effect on quality of life decreased by 18.8% for nausea and 22.8% for emesis according to the FLIE questionnaire scores," they further report.

CINV is the most common and distressing side effect of chemotherapy, which can seriously harm quality of life and reduce treatment adherence, the researchers point out. "Therefore, the prevention of CINV has a vital role in the overall management of anticancer treatment."

This study shows that adding aprepitant to palonosetron and dexamethasone is effective in reducing CINV in women who received moderately emetogenic chemotherapy, Dr. Li and colleagues say.

They note that this study only examined the prevention of CINV during the first course of chemotherapy. The role of aprepitant in anticipatory vomiting and during the complete treatment regimen is unknown. Another limitation is the inclusion of only women younger than age 50 years with little or no alcohol use.

This work was supported, in part, by the National Natural Science Foundation of China.

Dr. Li did not respond to a request for comment by press time.

SOURCE: https://bit.ly/3thE8Cy JAMA Network Open, online April 9, 2021.

By Reuters Staff



Posted on 19 April 202120 April 2021