Prevention of Chemotherapy-Induced Nausea and Vomiting
Prevention of Chemotherapy-Induced Nausea and Vomiting
Studies evaluating the optimal use of antiemetics in settings where high-dose chemotherapy is administered have been lacking; however, a body of evidence in favor of NK1RAs is accumulating.
In a prospective, randomized study in 179 patients receiving a variety of high-dose cyclophosphamide preparative regimens before autologous or allogeneic stem-cell transplantation, an aprepitant/ondansetron/DEX regimen during and for 3 days after the preparative chemotherapy was compared with an ondansetron/DEX control. The aprepitant arm resulted in a superior CR rate over the 8–10 days of treatment compared with the control (82% versus 66%; P < 0.001).
In a recent randomized, double-blind, phase IIIb trial, a combination regimen of aprepitant (days 1–4)/granisetron (days 1–4)/DEX (days 2–3) was evaluated in 362 myeloma patients treated with high-dose melphalan for autologous transplantation. The aprepitant regimen resulted in significantly better CINV control compared with granisetron/DEX (overall CR: 58% versus 41%, P = 0.0042; no emesis: 78% versus 65%, P = 0.0036).
Data for the use of NK1RAs in this setting are compelling, with clinically and statistically significant benefits in favor of the NK1 regimen. Though not specifically recommended yet by guideline committees, the addition of a NK1RA in these settings might be considered.
High-dose Chemotherapy
Studies evaluating the optimal use of antiemetics in settings where high-dose chemotherapy is administered have been lacking; however, a body of evidence in favor of NK1RAs is accumulating.
In a prospective, randomized study in 179 patients receiving a variety of high-dose cyclophosphamide preparative regimens before autologous or allogeneic stem-cell transplantation, an aprepitant/ondansetron/DEX regimen during and for 3 days after the preparative chemotherapy was compared with an ondansetron/DEX control. The aprepitant arm resulted in a superior CR rate over the 8–10 days of treatment compared with the control (82% versus 66%; P < 0.001).
In a recent randomized, double-blind, phase IIIb trial, a combination regimen of aprepitant (days 1–4)/granisetron (days 1–4)/DEX (days 2–3) was evaluated in 362 myeloma patients treated with high-dose melphalan for autologous transplantation. The aprepitant regimen resulted in significantly better CINV control compared with granisetron/DEX (overall CR: 58% versus 41%, P = 0.0042; no emesis: 78% versus 65%, P = 0.0036).
Data for the use of NK1RAs in this setting are compelling, with clinically and statistically significant benefits in favor of the NK1 regimen. Though not specifically recommended yet by guideline committees, the addition of a NK1RA in these settings might be considered.
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