Aprepitant in patients with advanced non-small-cell lung cancer receiving carboplatin-based chemotherapy

• Published in: Lung cancer (Amsterdam, Netherlands) Vol. 84; no. 3; pp. 259 - 264
• Main Authors: Ito, Yasuhiro, Karayama, Masato, Inui, Naoki, Kuroishi, Shigeki, Nakano, Hideki, Nakamura, Yutaro, Yokomura, Koshi, Toyoshima, Mikio, Shirai, Toshihiro, Masuda, Masafumi, Yamada, Takashi, Yasuda, Kazumasa, Hayakawa, Hiroshi, Suda, Takafumi, Chida, Kingo
• Format: Journal Article
• Language: English
• Published: Oxford Elsevier 01.06.2014
• Subjects: Adult; Aged; Aged, 80 and over; Antiemetics - administration & dosage; Antineoplastic Agents - adverse effects; Biological and medical sciences; Carboplatin - administration & dosage; Carboplatin - adverse effects; Carcinoma, Non-Small-Cell Lung - drug therapy; Dexamethasone - administration & dosage; Drug Therapy, Combination; Female; Glutamates - administration & dosage; Glutamates - adverse effects; Guanine - administration & dosage; Guanine - adverse effects; Guanine - analogs & derivatives; Hematology, Oncology and Palliative Medicine; Humans; Lung Neoplasms - drug therapy; Male; Medical sciences; Middle Aged; Morpholines - administration & dosage; Multiple tumors. Solid tumors. Tumors in childhood (general aspects); Nausea - chemically induced; Nausea - prevention & control; Pemetrexed; Pneumology; Pulmonary/Respiratory; Serotonin - administration & dosage; Tumors; Tumors of the respiratory system and mediastinum; Vomiting - chemically induced; Vomiting - prevention & control; Aprepitant; Carboplatin; Non-small-cell lung cancer; Pemetrexed; Antiemetic; Chemotherapy-induced nausea and vomiting; Antineoplastic agent; Human; Lung disease; Respiratory disease; Lung cancer; Patient; Nausea; Malignant tumor; non-small cell lung carcinoma; Chemotherapy; Treatment; Vomiting; Digestive diseases; Bronchus disease; Advanced stage; Cancer
• ISSN: 0169-5002; 1872-8332
• DOI: 10.1016/j.lungcan.2014.03.017

Abstract Objectives Chemotherapy-induced nausea and vomiting (CINV) is an unanswered problem in cancer therapy. We evaluated the efficacy and safety of triple antiemetic therapy with aprepitant, a 5-hydroxytryptamine-3 (5-HT3 ) receptor antagonist, and dexamethasone in patients with advanced non-small-cell lung cancer (NSCLC) who received carboplatin-based first-line chemotherapy. Methods Chemotherapy-naïve patients with NSCLC were enrolled in this randomized phase-II study. Patients were randomized to standard antiemetic therapy with a 5-HT3 receptor antagonist and dexamethasone, and aprepitant add-on triple antiemetic therapy. The primary endpoint was the complete response rate (no vomiting and no rescue therapy) during the 120 h post-chemotherapy. Results A total of 134 patients were assigned randomly to the aprepitant group or the control group. The aprepitant group and the control group showed an overall complete response rate of 80.3% (95% confidence interval (CI), 69.2–88.1%) and 67.2% (95% CI, 55.3–77.2%; odds ratio (OR), 0.50; 95% CI, 0.22–1.10; p = 0.085), respectively. Among patients taking carboplatin and pemetrexed, adding aprepitant significantly improved the complete response rate in the overall phase (83.8% in the aprepitant group and 56.8% in the control group; OR, 0.26; 95% CI, 0.08–0.70; p < 0.01) and the delayed phase (86.5% in the aprepitant group and 59.1% in the control group; OR, 0.23; 95% CI, 0.07–0.65; p < 0.01). Conclusion Carboplatin-based chemotherapy has considerable emetic potential. Triple antiemetic therapy with aprepitant, a 5-HT3 receptor antagonist, and dexamethasone improved the control of CINV prevention in patients receiving carboplatin and pemetrexed chemotherapy.