Addition of aprepitant improves protection against cisplatin-induced emesis when a conventional anti-emetic regimen fails

• Published in: Cancer chemotherapy and pharmacology 2014-06, Vol.73 (6), p.1129-1136
• Main Authors: Hu, Weiheng, Fang, Jian, Nie, Jun, Dai, Ling, Chen, Xiaoling, Zhang, Jie, Ma, Xiangjuan, Tian, Guangming, Han, Jindi
• Format: Article
• Language: English
• Subjects: Adult; Aged; Antiemetics - adverse effects; Antiemetics - therapeutic use; Antineoplastic agents; Antineoplastic Combined Chemotherapy Protocols - adverse effects; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Biological and medical sciences; Cancer Research; Cisplatin - administration & dosage; Cisplatin - adverse effects; Female; Humans; Lung Neoplasms - drug therapy; Male; Medical sciences; Medicine; Medicine & Public Health; Middle Aged; Morpholines - adverse effects; Morpholines - therapeutic use; Nausea - chemically induced; Nausea - drug therapy; Nausea - prevention & control; Oncology; Original Article; Pharmacology. Drug treatments; Pharmacology/Toxicology; Prospective Studies; Treatment Outcome
• ISSN: 0344-5704; 1432-0843
• DOI: 10.1007/s00280-014-2446-4

Objective We investigated whether aprepitant, a neurokinin-1 antagonist, could decrease chemotherapy-induced nausea and vomiting (CINV) following cisplatin, when a conventional anti-emetic regimen had failed. Methods This was a prospective study (April 2011–April 2012) of patients with lung cancer, treated with cisplatin at the Beijing Cancer Hospital, and initially receiving granisetron, dexamethasone, and metoclopramide as anti-emetics. If patients experienced vomiting of grade ≥2 and required rescue anti-emetic medications during the first cycle, oral aprepitant was added in subsequent cycles (day 1: 125 mg; days 2–3: 80 mg once daily). Acute (day 1) and delayed (days 2–5) nausea and vomiting, use of rescue medications, and occurrence of adverse reactions were monitored after the start of chemotherapy. Results Twenty-five of 132 patients (18.9 %) were administered aprepitant for secondary prophylaxis against emesis during the second cycle of chemotherapy. The incidences of acute and delayed nausea were 52 and 100 % in the first cycle, but 8 and 72 % in the second cycle. The incidences of acute and delayed vomiting were 20 and 100 % in the first cycle, but 0 and 36 % in the second cycle. No patients required rescue medications or intravenous rehydration during the second cycle. Aprepitant was not associated with additional adverse events. Conclusions In patients with lung cancer receiving cisplatin-based chemotherapy, the addition of aprepitant to a 5-HT 3 antagonist, dexamethasone, and metoclopramide improves protection against CINV when the conventional anti-emetic regimen fails.