Antiemetic medication efficacy during EPOCH and R-EPOCH treatment

Abstract

Introduction This study aims to determine the adequacy of current institutional standard practice for CINV prophylaxis for EPOCH and R-EPOCH at The Ohio State University James Cancer Hospital. Methods Single-center, retrospective analysis was performed including all patients receiving EPOCH or R-EPOCH chemotherapy for Non-Hodgkin’s lymphomas from 1/1/2012 to 6/30/2017. The primary endpoint was rate of CINV events, which included usage of more than 50 percent of available doses of breakthrough antiemetics while inpatient, hospitalization due to CINV or related complications, or adjustments made to the CINV prophylactic or breakthrough regimen during current or subsequent cycles. Secondary endpoints included determining prescriber adherence to institutional standard CINV prophylaxis, characterization of adjustments to the antiemetic regimen following the incidence of CINV, and identification of high-risk patients that may benefit from additional CINV prophylaxis. Results Of 111 patients, 54 (48.6%) experienced CINV events with any cycle of EPOCH or R-EPOCH chemotherapy. Of those patients, 17 (31.5%) received institutional standard CINV prophylaxis at baseline, 8 (14.8%) received additional scheduled antiemetics, and 26 (48.1%) were prescribed additional breakthrough antiemetics with their first cycle of EPOCH or R-EPOCH. Younger age, diagnosis of anxiety, and previous susceptibility to nausea were significantly associated with CINV events. Conclusion This study illustrates the inadequacy of current institutional standard for CINV prophylaxis for patients receiving EPOCH and R-EPOCH, highly emetogenic chemotherapy regimens. With nearly half of included patients experiencing CINV events, and most initially receiving more than our standard prophylaxis, changes to our standard antiemetics used with this chemotherapy regimen are needed.

Addition of an NK1 receptor antagonist to standard antiemetic prophylaxis in patients with B-cell lymphoma receiving EPOCH

“…It is critical to report our rates of CINV from those reporting emetogenicity of highly emetogenic multiday chemotherapy for hematologic malignancies. In one study with a similar population of 111 patients with lymphoma receiving DA-EPOCH or DA-R-EPOCH, 48.6% of patients receiving prophylactic antiemetics without NK1RA experienced a CINV event during their treatment [4] compared to 58.3% of our non-NK1RA patients who did not achieve CR. Another study examining patients with acute leukemia receiving induction with moderately emetogenic multiday chemotherapy, reported that the patients who received 5HT3RA-only prophylaxis experienced a 32.6% CR [15], similar to our without NK1RA group's CR of 41.7%.…”

“…A subgroup analysis revealed that men in the NK1RA group had improved CR, while women had similar CR in both the NK1RA and without NK1RA groups. Overall, these data add to the growing body of evidence describing the unmet clinical need for adults with hematologic malignancies receiving multiday chemotherapy and experiencing CINV [3,4,[14][15][16].…”

“…Data for emetogenicity of the AC combination within DA-R-EPOCH is limited, but prior studies have found that providing moderate emetogenicity chemotherapy prophylaxis is suboptimal [3,4]. In one study, researchers evaluating their institutional DA-R-EPOCH CINV moderate-emetogenic risk prophylaxis with ondansetron and prednisone found that 48.6% of patients experienced CINV events with any cycle of DA-R-EPOCH [4], highlighting the challenges of optimal CINV prophylaxis in multiday chemotherapy. Another single-center study of people receiving DA-R-EPOCH, most of whom received only moderate emetogenicity prophylaxis with a corticosteroid and a 5-hydroxytryptamine-3 receptor antagonist (5HT3RA), observed that CINV complete response (CR), de ned as no breakthrough antiemetic medication utilization and no documented vomiting over 120 hours, was only 32% [3].…”

“…Data for emetogenicity of the AC combination within DA-R-EPOCH is limited, but prior studies have found that providing moderate emetogenicity chemotherapy prophylaxis is suboptimal [3,4]. In one study, researchers evaluating their institutional DA-R-EPOCH CINV moderate-emetogenic risk prophylaxis with ondansetron and prednisone found that 48.6% of patients experienced CINV events with any cycle of DA-R-EPOCH [4], highlighting the challenges of optimal CINV prophylaxis in multiday chemotherapy.…”