Efficacy and Safety of Aprepitant in Combination with Dexamethasone, Granisetron and Metoclopramide as a Prophylaxis of Chemotherapy-Induced Nausea and Vomiting in a Acute and Delayed Emesis in Arab Cancer Patient

Abstract

Background: Chemotherapy Induced Nausea and Vomiting (CINV) is one of the greatest sources of distress for patients. Severe CINV may force interruption of chemotherapy, it is important to control CINV to achieve successful chemotherapy. Objective: This study to evaluate the efficacy and safety of aprepitant in a regimen containing aprepitant in combination with dexamethasone, granisetron and metoclopramide (APRDGM) versus a regimen dexamethasone, granisetron and metoclopramide (DGM) only, as a prophylaxis in (CINV) in highly emetogenic chemotherapy(HEC) in Arabic cancer patients. Setting: This study was conducted at King Abdul-Aziz Medical city (Eastern Region, AlHasa, Saudi Arabia). Methods: 309 patients all Arab population, treated with HEC, were enrolled in a retrospective, cohort study to investigate the efficacy and safety of (APR-DGM) compared to (DGM) regimen. Main outcome measure: The primary efficacy endpoint was the complete response (CR) for acute emesis and determines the adverse drug events. Secondary endpoint was the CR for delayed emesis. Results: The APR-DGM regimen showed a significantly improved control in the management of CINV in patients treated with HEC in acute emesis compared to the DGM regimen (P=0.0021). No significant difference was observed between the two regimens regards to delayed emesis (P=0.145). Both regimens were well tolerated, and the rates of adverse events were not significantly different between the regimens. Conclusion: The addition of aprepitant to the standard regimen of dexamethasone, granisetron and metoclopramide was found to be significantly better than dexamethasone, granisetron and metoclopramide alone, but only in the control of acute emesis, with no significant change in delayed emesis in Arab population.