Addition of 3-day aprepitant to ondansetron and dexamethasone for prophylaxis of chemotherapy-induced nausea and vomiting among patients with diffuse large B cell lymphoma receiving 5-day cisplatin-based chemotherapy

• Published in: Journal of Egyptian National Cancer Institute Vol. 29; no. 3; pp. 155 - 158
• Main Authors: Abdel-Malek, Raafat, Abbas, Noha, Shohdy, Kyrillus S., Ismail, Mohamed, Fawzy, Radwa, Salem, Dalal S., Safwat, Ezzat
• Format: Journal Article
• Language: English
• Published: Cairo, Egypt Elsevier B.V 01.09.2017; Cairo University, National Cancer Institute; SpringerOpen
• Subjects: Adult; Antiemetics - administration & dosage; Antineoplastic Combined Chemotherapy Protocols - adverse effects; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Aprepitant; Chemoprevention; Cisplatin - administration & dosage; Dexamethasone - administration & dosage; Drug Administration Schedule; Drug Therapy, Combination; Female; Humans; Lymphoma; Lymphoma, Large B-Cell, Diffuse - complications; Lymphoma, Large B-Cell, Diffuse - drug therapy; Male; Middle Aged; Morpholines - administration & dosage; Multi-day cisplatin; Nausea; Nausea - etiology; Nausea - prevention & control; Ondansetron - administration & dosage; Pilot Projects; Time Factors; Treatment Outcome; Vomiting; Vomiting - etiology; Vomiting - prevention & control; Aprepitant; Multi-day cisplatin; Nausea; Vomiting; Lymphoma
• ISSN: 1110-0362; 1687-9996; 2589-0409
• DOI: 10.1016/j.jnci.2017.05.001

Neurokinin-1 receptor antagonists, such as aprepitant are currently emerging as powerful prophylactic agents for chemotherapy-induced nausea and vomiting (CINV). Therefore, it is important to adjust the anti-emetic regimens based on personal risk factors of the patient, duration of the chemotherapy regimen and cost-effectiveness. To determine the efficacy of the 3-day aprepitant along with ondansetron and dexamethasone in controlling CINV in patients with large B cell lymphoma receiving multiday-cisplatin regimen chemotherapy. This is a pilot prospective cross-over trial. Patients were allocated to either aprepitant 125mg on day 1 and 80mg on days 2 & 3 or placebo in the first 2 cycles, with crossover to the opposite treatment in the 3rd and 4th cycles. The primary end point was complete response (CR) of both acute (days 1–5) and delayed (days 6–8) CINV. CR means neither to develop emetic episodes nor to use rescue anti-emetics medication. Twelve of the 15 patients recruited for the study were fully evaluable and completed 4 cycles of ESHAP regimen with a total of 48 cycles given. In the cycles with aprepitant and those without the CR were 83.3% and 0% respectively (p<0.05). Patients receiving aprepitant in the first 2 cycles recorded less nausea in subsequent cycles that were given without aprepitant. This was not statistically significant. This triple anti-emetic regimen showed efficacy in controlling the multi-day cisplatin-induced nausea and vomiting. Further randomized controlled trials are needed to compare between 3-day and 7-day aprepitant for multi-day cisplatin regimens.