Chemotherapy regimens differ according to the
tumor type being treated and are associated with varying degrees of emetogenic potential. Since the distribution of risk factors for
chemotherapy-induced
nausea and
vomiting differs across
tumor types, it is important to understand the efficacy of
antiemetic regimens in multiple patient populations. To characterize treatment response in patients with various
malignancies (e.g., breast, gastrointestinal, genitourinary, and lung) treated with either highly emetogenic
chemotherapy (HEC) or moderately emetogenic
chemotherapy (MEC) regimens, a pooled analysis of patient-level data from 4 large randomized trials was performed (N=2813). Patients receiving an
antiemetic regimen containing
aprepitant,
ondansetron, and
dexamethasone were compared with patients receiving an active-control
antiemetic regimen containing
ondansetron plus
dexamethasone. In all
tumor types analyzed, complete responses were observed in a higher proportion of HEC-treated patients receiving
aprepitant compared with active-control patients (genitourinary [61.5% vs 40.6%, P<0.001], gastrointestinal [68.2% vs 44.7%, P=0.013], and
lung cancers [73.5% vs 52.8%, P<0.001]). For MEC-treated patients, complete response rates were also higher for
aprepitant patients than active-control patients for all
tumor types, with a significant difference noted among patients with
breast cancer (54.9% vs 43.9%, P<0.0001). The proportion of patients with no
vomiting was higher in both HEC- and MEC-treated patients. While results of previous studies provide support for the use of
antiemetic regimens that include
aprepitant, a selective
5-hydroxytryptamine-3 receptor antagonist, and
dexamethasone, this analysis demonstrates the consistent efficacy of
aprepitant as part of an
antiemetic regimen across different
tumor types and
chemotherapy regimens.