Aprepitant as salvage antiemetic therapy in breast cancer patients receiving doxorubicin and cyclophosphamide

Abstract

In breast cancer patients receiving AC, the addition of aprepitant to a 5-HT(3) antagonist and dexamethasone during cycle 2 of treatment improved antiemetic outcome. Although the improvement in the primary endpoint of complete control during cycle 2 was not significant, all secondary endpoints such as complete response and no emesis rates were significantly better during cycle 2. The extent of antiemetic control during cycle 2 was numerically inferior to the results achieved in a phase III trial employing aprepitant with cycle 1 of AC chemotherapy, suggesting that the preferred approach is to include aprepitant with the initial cycle of AC chemotherapy.

Antiemetic therapy for multiple-day chemotherapy and additional topics consisting of rescue antiemetics and high-dose chemotherapy with stem cell transplant: review and consensus statement

“…Recent data suggesting that the mechanism of action of palonosetron may differ from that of other serotonin antagonists [22] could provide a rationale for additional activity with this agent. More recently, several studies [23,24] have documented antiemetic activity of the NK-1 antagonists in patients who did not achieve complete protection from emesis when treated with dexamethasone and a serotonin receptor antagonist alone.…”

Controlling Chemotherapy-Induced Nausea and Vomiting with Neurokinin-1 Receptor Antagonists in Patients on AC-Based Chemotherapy—Are We There Yet?

“…receive a course of MEC for the treatment of a solid malignant tumor. Four APR RCTs [12,19,21,22], 1 APR OS [20] and 1 CAS RCT [11] required patients to be on AC-based or AC-only chemotherapy. One CAS RCT and 1 APR OS included patients on other MECs such as fluorouracil, oxaliplatin [18], irinotecan [17,18], carboplatin, idarubicin, ifosfamide, mitoxantrone and ≤50 mg/m 2 of cisplatin [17].…”

“…To minimize the contribution of anticipatory nausea and vomiting to CINV, 6 studies excluded patients who experienced nausea or vomiting in the 24 hours preceding chemotherapy [12,17,18,[20][21][22]. Both APR OSs [17,20] specifically stated the use of the National Cancer Institute Common Toxicity Criteria (Version 3) [24], which was not mentioned in the other 4 studies [12,18,21,22].…”

“…Both APR OSs [17,20] specifically stated the use of the National Cancer Institute Common Toxicity Criteria (Version 3) [24], which was not mentioned in the other 4 studies [12,18,21,22]. The study by Hesketh et al [20] excluded patients who experienced nausea greater or equal to Grade 1, while that of Grote et al [17] only excluded patients who had experienced nausea corresponding to Grade 2 or 3.…”

“…The 5HT 3 -RAs administered differed between the APR OSs and other studies. While only ondansetron was administered in both APR and CAS RCTs [11,12,18,19,21,22], the OS by Hesketh et al [20] (study 5) also included patients who received granisetron and dolasetron. All patients in the OS by Grote et al [17] (study 6) were administered palonosetron.…”