Impact of aprepitant on emesis control, dose intensity, and recurrence-free survival in a population-based cohort of head and neck cancer patients receiving high-dose cisplatin chemotherapy.

Abstract

BACKGROUND:

Standard care for locally advanced head and neck cancer (HNC) patients consists of high-dose cisplatin with radiation to prolong recurrence-free survival (RFS). However, poorly controlled emesis can compromise optimal dose intensity (DI) and affect disease control.

OBJECTIVE:

To evaluate the impact of aprepitant on emesis control, DI, and RFS.

METHODS:

HNC patients treated at the British Columbia Cancer Agency were analyzed. Kaplan-Meier method and adjusted Cox proportional hazard models were used to evaluate RFS in aprepitant users. To control for selection bias, a propensity score analysis was conducted.

RESULTS:

A total of 192 HNC patients were included: 141 received aprepitant prophylaxis. The aprepitant-treated and untreated groups were comparable in mean age (56.3 vs 58.1 years), male gender (82.3% vs 86.3%), tumor location, and number of metastatic sites. However, more patients in the aprepitant group than in the untreated group had surgically resectable disease (31.2% vs 15.7%, respectively) and better performance status (ECOG 0/1, 87.9% vs 76.4%). Less emesis was reported in the aprepitant group (21.3% vs 28.0%). Patients in the treated group were also more likely to complete 3 cycles of high-dose cisplatin (OR, 2.3; P = .03). The propensity score adjusted Cox regression analysis suggested a reduced risk of disease recurrence in patients who received aprepitant (HR, 0.47; 95% CI, 0.17- 1.28).

LIMITATIONS:

Potential confounders such as other diseases or treatments that may have influenced the presence of nausea/emesis symptoms.

CONCLUSION:

Aprepitant contributed to improved emesis control, enhanced DI, and better adherence to cisplatin chemotherapy.

• Authors: Serge Makarenko, George Dranitsaris, Renata D Peixoto, Jenny Y Ruan, Winson Y Cheung
• Journal: The Journal of community and supportive oncology (J Community Support Oncol) Vol. 12 Issue 11 Pg. 394-400 (Nov 2014) ISSN: 2330-7749 [Print] United States
• PMID: 25856012 (Publication Type: Journal Article)
• Copyright: ©2014 Frontline Medical Communications.