Abstract
Objective: The purpose of this study was to define the incidence of chemotherapy-induced nausea and vomiting (CINV) in newly diagnosed cervical cancer patients receiving cisplatin and radiation treatment; and to determine if the granisetron transdermal patch (Sancuso?) would be appropriate to recommend as part of standard antiemetic regimen for the cisplatin radiation chemotherapy order set. Methods: This is a retrospective case-controlled study of cervical cancer patients receiving cisplatin chemotherapy with radiation (cisXRT); comparing patients receiving the granisetron transdermal patch to matched patients receiving oral 5HT3 blockers. All patients prescribed cisXRT between September 15th 2008 and November 30, 2011 were identified using pharmacy dispensing records. Patients were included if they received at least a partial dose of cisXRT and Sancuso? patch as standard antiemetic prophylaxis prior to cisXRT for cervical cancer treatment. Exclusion criteria included concomitant investigational agents, biotherapy and/or chemotherapy agents; prior chemotherapy; or incomplete or restricted medical records. Patients will be matched based on age. Patients were matched 3:1 (oral:patch). A total of 404 patients that received and completed cisXRT were identified utilizing an existing de-identified database from previous study were reviewed to evaluate parameters of interest. Results: A total of 285 patients’ medication records were reviewed for Sancuso? use, and 47 were identified. Of these 47 charts only five patient cases met eligibility criteria to be included in the study. All five patients that received the granisetron patch had at least three known risk factors for nausea. The nausea/vomiting in these patients did not worsen after receiving the Sancuso? patch, and four out of five had subjective improvement. CINV was unrelated to changes in laboratory values or incidence of other toxicity and was not dose-related. Conclusions: While no definitive conclusions could be drawn from this retrospective analysis, the limited data suggests that patients’ nausea and vomiting did not worsen after receiving the Sancuso? patch, and four out of five patients had subjective improvement. The challenges met and limitations identified justify the need for a prospective study that is now underway to control other contributing variables and evaluate overall efficacy of the granisetron patch for controlling CINV in patients receiving cisplatin plus radiation.
Highlights
IntroductionThe incidence of cervical cancer is decreasing in the United States
With current screening tools, the incidence of cervical cancer is decreasing in the United States
The purpose of this study was to define the incidence of chemotherapy-induced nausea and vomiting (CINV) in newly diagnosed cervical cancer patients receiving cisplatin and radiation treatment; and to determine if the granisetron transdermal patch (Sancuso®) would be appropriate to recommend as part of standard antiemetic regimen for the cisplatin radiation chemotherapy order set
Summary
The incidence of cervical cancer is decreasing in the United States. In 2012 there will be an estimated 12,170 new cases of and 4220 deaths in the United States from cervical cancer [1]. Treatment typically consists of either primary surgery or primary radiation combined with chemotherapy. Peters and colleagues studied the addition of cisplatin-based chemotherapy to radiation therapy compared to radiation therapy alone in postoperative patients with early stage cancer [2]. This study demonstrated a decrease in recur-. Rence and improvements in progression-free and overall survival when chemotherapy was added to pelvic radiation therapy [2]. This demonstrated improvement came with the addition of greater toxicity
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