Abstract
BackgroundChemotherapy-induced nausea and vomiting (CINV) is a major adverse toxicity of cancer chemotherapy. Recommended treatments for prevention of CINV vary among published guidelines, and optimal care for CINV caused by moderately emetogenic chemotherapy has not been established. This study assessed the efficacy and safety of triple antiemetic therapy comprising palonosetron, dexamethasone and aprepitant for carboplatin-based chemotherapy. Chemotherapy-naïve patients with lung cancer scheduled for a first course of a carboplatin-containing regimen formed the study cohort. Patients were pretreated with antiemetic therapy comprising palonosetron (0.75 mg, i.v.) and dexamethasone (9.9 mg, i.v.) on day 1, and aprepitant (125 mg, p.o.) on day 1 followed by 80 mg on days 2 and 3. Primary endpoint was the proportion of patients who did not experience vomiting and did not require rescue medication [complete response (CR)] in the acute phase (0–24 h), late phase (24–168 h) and overall. Secondary endpoint was the proportion of patients who experienced no vomiting episodes and no more than mild nausea without the need for rescue medication [complete control (CC)].ResultsPrevalence of a CR during the acute phase, delayed phase, and overall was 100, 91.9 and 91.9%, whereas that of CC was 100, 84.4 and 84.4%, respectively. The most common adverse event was mild constipation; severe adverse events related to antiemetic treatment were not observed.ConclusionTriple antiemetic therapy comprising palonosetron, dexamethasone and aprepitant shows excellent effects in the prevention of CINV in patients receiving a carboplatin-containing regimen.
Highlights
Chemotherapy-induced nausea and vomiting (CINV) is a major adverse toxicity of cancer chemotherapy
Despite the introduction of antiemetic treatments such as corticosteroids, 5-hydroxytryptamine-3 (5-HT3) receptor antagonists, and neurokinin-1 (NK-1) receptor inhibitors, chemotherapy-induced nausea and vomiting (CINV) remains a major toxicity of cancer chemotherapy that reduces the quality of life (QOL) of cancer patients
Guidelines state that antiemetic treatments should be adopted according to the category of emetic risks, but there are some differences in the recommendations for moderately emetogenic chemotherapy (MEC) among such guidelines
Summary
Chemotherapy-induced nausea and vomiting (CINV) is a major adverse toxicity of cancer chemotherapy. This study assessed the efficacy and safety of triple antiemetic therapy comprising palonosetron, dexamethasone and aprepitant for carboplatin-based chemotherapy. Despite the introduction of antiemetic treatments such as corticosteroids, 5-hydroxytryptamine-3 (5-HT3) receptor antagonists, and neurokinin-1 (NK-1) receptor inhibitors, chemotherapy-induced nausea and vomiting (CINV) remains a major toxicity of cancer chemotherapy that reduces the quality of life (QOL) of cancer patients. Guidelines set by the American Society of Clinical Oncology recommend a two-drug combination comprising palonosetron and dexamethasone as antiemetic treatment for MEC (Basch et al 2011). Guidelines set by the National Comprehensive Cancer Network recommend a double combination of a 5-HT3 receptor antagonist and dexamethasone, and an additional NK-1 inhibitor (e.g., aprepitant) is recommended for patients treated with a carboplatin- or irinotecan-containing regimen (Ettinger et al 2012). Antiemetic therapy should aim to minimize or eliminate CINV in an optimal manner in all cancer patients, so the methods of CINV control can be improved further
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