Prevalence of chemotherapy-induced nausea and vomiting with moderately emetogenic chemotherapy in platinum-based regimens.

Abstract

e24131 Background: Kaiser Permanente East Bay considers cisplatin ≤40 mg/m2, carboplatin at any AUC, and oxaliplatin at any dose as moderate emetogenic risk where patients are administered 5-hydroxytriptamine type 3-receptor antagonist (5-HT3 RA) and dexamethasone. However, national guidelines differ in their management with cisplatin and carboplatin of AUC ≥4. Moreover, it has been noted within our institution that patients receiving oxaliplatin often require escalation of antiemetic regimen despite 5-HT3 RA and dexamethasone prophylaxis. The objective of the study was to determine the prevalence of CINV in patients receiving platinum-based chemotherapy despite moderate prophylaxis for cycle 1. Methods: The study was a retrospective single-center cohort-control analysis assessing patients from Kaiser Permanente East Bay initiated on cycle 1 with carboplatin AUC ≥4, low dose cisplatin ≤40 mg/m2, or any dose of oxaliplatin. Evaluation of CINV was defined as rates of no complete response (emesis or use of rescue) during the acute (0 – 24 hours), delayed (24 – 120 hours) and overall periods (0-120 hours) after cycle 1 of treatment. A descriptive analysis was performed for the primary endpoint where the rate of no complete response (emesis or use of rescue) was expressed using the percentage of patients with the outcome. For the secondary endpoint, the patient-related risk factors associated with no complete response were determined by chi-squared for univariate covariates. Results: Between January 2016 to August 2019, 90 patients on cisplatin ≤40 mg/m2, 243 patients on carboplatin AUC ≥4, and 204 patients on any dose of oxaliplatin were enrolled in the study. The percentages of patients who had no complete response were 16%, 13%, 11% in the acute phase; 39%, 34%, and 38% in the delayed phase; 47%, 36%, and 39% in the overall phase, respectively. Univariate analysis using chi-squared revealed that age less than 60 years and females were associated with an increased risk for no complete response in the overall phase. In contrast, prior chemotherapy was significantly associated with a decreased risk in the overall phase. Conclusions: The prevalence of CINV despite moderate antiemetic management at Kaiser Permanente East Bay is more prominent in the delayed phase compared to the acute phase and consistent with trends determined in literature. Patients who are younger than 60 years of age, who are female, or had no prior history of chemotherapy are relevant risk factors associated with CINV in our patient demographics.