5-Hydroxytryptamine-3 receptor antagonist and dexamethasone as prophylaxis for chemotherapy-induced nausea and vomiting during moderately emetic chemotherapy for solid tumors: a multicenter, prospective, observational study

Abstract

Background Of patients receiving moderate emetic risk chemotherapy (MEC), 30–90% experience chemotherapy-induced nausea and vomiting (CINV); however, the optimal antiemetic treatment remains controversial. Methods In this multicenter, prospective, observational study of adults treated with MEC while receiving chemotherapy for various cancer types in Japan, the enrolled patients kept diaries documenting CINV. All participants received a 5-hydroxytryptamine-3 receptor antagonist and dexamethasone. Results Of the 400 patients enrolled from May 2013 to January 2015, 386 were eligible for evaluation. The median age was 64 (range, 26–84). The overall complete response (CR; no emetic events and no antiemetic measures) rate was 64%. The proportion of patients showing CR was low in the carboplatin (CBDCA)- and oxaliplatin-based chemotherapy groups, especially among women. We showed that the CR rates in men were high in the CBDCA (AUC5) + etoposide (ETP) (80%), capecitabine plus oxaliplatin (CAPOX) (78%), and CBDCA+ paclitaxel (PTX) groups for lung cancer (73%). Total control (TC; no emetic events, no antiemetic measures, and no nausea) and complete control (CC; no emetic events, no antiemetic measures, and less than mild nausea) were achieved in 51 and 61% of patients, respectively. Logistic regression analysis revealed history of motion sickness, history of pregnancy-associated vomiting and CBDCA-based chemotherapy as risk factors for CR and history of motion sickness and history of pregnancy-associated vomiting as risk factors for TC. Additional, Ages ≥65 years is an independent predictive factor for achieving TC. Conclusions Our data showed that two antiemetics were insufficient to control CINV in patients receiving CBDCA- or oxaliplatin-based chemotherapy. However, two antiemetics may be sufficiently effective for elderly male patients receiving CBDCA (AUC5) + ETP, CBDCA+PTX for lung cancer, or CAPOX. Additionally, we consider that three antiemetics are necessary for women with colorectal cancer receiving CAPOX. Risk factor analysis related to CR showed that CINV prophylaxis in patients treated with CBDCA-based chemotherapy was generally supportive of the guideline-recommended three antiemetics. However, the control of nausea in patients receiving non-CBDCA-based chemotherapy is a key point to note. The further individualization of antiemetic regimens for patients receiving MEC based on both types of chemotherapy regimens and sex is needed.

Low Dose Olanzapine in the Prevention Carboplatin Induced Nausea and Vomiting: a Prospective Randomized Controlled Trial

“…Various studies had shown that female and nondrinker has a high risk of CINV, and carboplatin combination chemotherapy has a low control rate in prevention CINV in gynecologic cancer [13,17,18] . In addition, the median age of the patients in this study is 62 years old, researches about prevention of CINV suggested that control rate increases along with the age of the patients, age of 65 and younger is one of the risk factors may explain the lower TC rate in this study [13,19] . Again, another reason that could explain the comparatively lower TC rate in this study is due to the prevalence of the immune checkpoint inhibitors in recent years, Arbour et al reported that corticosteroid lowers the therapeutic effect of such medications [20] .…”

Chemotherapy-induced nausea and vomiting (CINV) with carboplatin plus pemetrexed or carboplatin plus paclitaxel in patients with lung cancer: a propensity score-matched analysis

“…CINV in patients receiving CBDCA+PTX can be controlled relatively well by two antiemetics [8,15]. Ito et al [8] reported that the CBDCA+PEM regimen had relatively high emetic potential, and triple antiemetic therapy with a 5-HT3 receptor antagonist, DEX, and aprepitant may be an effective prophylactic treatment in patients receiving the CBDCA+PEM regimen.…”

“…We analyzed pooled data of 240 patients from two multicenter, prospective, observational studies. Individual study results were previously published [14,15]. The patient selection flowchart is shown in Fig.…”

“…This study was approved by the institutional review board of Fukuoka University (H20-08-004). The datasets used for this study were provided by the principal investigators of studies A [14] and B [15].…”

Palonosetron <i>versus</i> Granisetron in Combination with Aprepitant and Dexamethasone for the Prevention of Chemotherapy-Induced Nausea and Vomiting after Moderately Emetogenic Chemotherapy: A Single-Institutional Retrospective Cohort Study

“…Several antiemetic agents have been developed such as 5-hydroxytryptamine-3 receptor antagonists (5-HT 3 RAs) and the neurokinin-1 receptor antagonist (NK-1 RA) aprepitant (Apr). Consensus guidelines [3][4][5][6] for the prophylaxis of CINV are primarily based on the emetogenic potential of chemotherapy. However, moderately emetogenic chemotherapy (MEC) agents have a broad range of emetogenicity (30-90%) relative to that of agents categorized by other emetogenic risks.…”