According to international guidelines, > 90% of patients on a cisplatin regimen experience chemotherapy-induced nausea and vomiting (CINV). Antiemetic prophylaxis with a 5 hydroxytryptamine receptor-3 antagonist (5-HT3RA) plus dexamethasone still leaves about 20% of patients with acute or delayed vomiting and nausea during the first cycle of chemotherapy. However, researchers from Chang Gung University in Taiwan found that adding aprepitant provided about 70% complete protection against emesis when the primary prophylaxis did not work. Those findings led them to conduct a study that evaluated the antiemetic efficacy of a combination of 3 drugs: palonosetron (a long-acting second-generation 5-HT3RA), 3-day oral aprepitant (a neurokinin-1 receptor antagonist), and dexamethasone.
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Patients in the study were scheduled to receive at least 50 mg/m2 cisplatin followed by a continuous infusion of 5-fluorouracil (5-FU) with or without other chemotherapeutic agents. Cisplatin was given on day 1; the other drugs were given on day 1 and subsequent days. All 69 patients who received palonosetron, aprepitant, and dexamethasone were evaluated in the first cycle of chemotherapy.
No patients experienced acute vomiting; nearly all (98.6%) were protected against nausea. Moreover, 97.1% had no delayed vomiting, and 87% had no delayed nausea. Most episodes of delayed nausea were rated as mild. Overall, 97.1% of patients had no vomiting, and 85.5% of patients had no nausea.
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The effects were sustained. In the second cycle of chemotherapy, again, none of 61 evaluated patients experienced acute vomiting, and 96.7% were free of nausea. Most patients also were protected against delayed vomiting or nausea (96.7% and 83.6%, respectively). Of patients who underwent 2 cycles, 45 did not experience nausea or vomiting in either cycle.
The combination of drugs was generally well tolerated; most adverse events were mild.
Yang C-K, Wu C-E, Liaw C-C. Biomed J. 2016;39(1):60-66.
doi: 10.1016/j.bj.2015.08.006.