Prophylactic aprepitant is better than salvage for carboplatin-based chemotherapy: a propensity score-matched analysis.

Abstract

Aprepitant prevents chemotherapy-induced nausea and vomiting (CINV) in carboplatin-containing chemotherapy. However, it is unknown whether aprepitant salvage therapy after the development of emesis is as effective as adding prophylactic aprepitant to doublet therapy with dexamethasone and a 5-HT3 receptor antagonist from the first cycle of chemotherapy. To compare the antiemetic efficacy of aprepitant between salvage and prophylactic administration in the second cycle of carboplatin-containing chemotherapy, twenty-two NSCLC patients who developed CINV in the first cycle of carboplatin-containing therapy without aprepitant (salvage group) and 44 patients who received aprepitant (prophylaxis group) were extracted from the pooled data of two clinical trials, with adjustment for age, sex, and chemotherapeutic regimen as co-variables using propensity score matching. In the second cycle of chemotherapy, both groups received aprepitant, and the rate of antiemetic complete response (no vomiting and no rescue therapy) at 5 days after chemotherapy was compared. The prophylaxis group demonstrated a significantly better overall complete response rate (88.6%; 95% confidence interval [CI] 75.4-96.2) compared with that of observed for the salvage group (68.2%; 95% CI 45.1-86.1, p = 0.042). The prophylaxis group also demonstrated a significantly lower proportion of any-grade nausea (43.2%) and appetite loss (43.2%) than the salvage group (72.7%, p = 0.036 and 77.3%, p = 0.010, respectively). Adding aprepitant to doublet therapy from the first cycle of carboplatin-containing chemotherapy may be more effective than salvage use of aprepitant after the development of CINV.

• Authors: Masato Karayama, Naoki Inui, Kazuki Tanaka, Hideki Yasui, Hironao Hozumi, Yuzo Suzuki, Kazuki Furuhashi, Tomoyuki Fujisawa, Noriyuki Enomoto, Yutaro Nakamura, Takafumi Suda
• Journal: Medical oncology (Northwood, London, England) (Med Oncol) Vol. 35 Issue 11 Pg. 139 (Sep 05 2018) ISSN: 1559-131X [Electronic] United States
• PMID: 30187148 (Publication Type: Journal Article)

Chemical References

• Antiemetics
• Aprepitant
• Carboplatin

Topics

• Adult
• Aged
• Antiemetics (administration & dosage)
• Antineoplastic Combined Chemotherapy Protocols (administration & dosage)
• Aprepitant (administration & dosage)
• Carboplatin (administration & dosage, adverse effects)
• Carcinoma, Non-Small-Cell Lung (diagnosis, drug therapy)
• Female
• Humans
• Lung Neoplasms (diagnosis, drug therapy)
• Male
• Middle Aged
• Nausea (chemically induced, diagnosis, prevention & control)
• Pre-Exposure Prophylaxis (methods)
• Propensity Score
• Prospective Studies
• Salvage Therapy (methods)
• Vomiting (chemically induced, diagnosis, prevention & control)