Aprepitant for refractory cutaneous T-cell lymphoma-associated pruritus: 4 cases and a review of the literature

Abstract

BackgroundAprepitant is an FDA-approved medication for chemotherapy-induced nausea and vomiting. It blocks substance P binding to neurokinin-1; substance P has been implicated in itch pathways both as a local and global mediator.Case presentationsWe report a series of four patients, diagnosed with cutaneous T-cell lymphoma, who experienced full body pruritus recalcitrant to standard therapies. All patients experienced rapid symptom improvement (within days) following aprepitant treatment.ConclusionAprepitant has been shown in small studies to be efficacious for treating chronic and malignancy-associated pruritus. Prior studies have shown no change in clinical efficacy of chemotherapeutics with concurrent aprepitant administration. These cases further demonstrate that aprepitant can be considered as a therapeutic option in malignancy-associated pruritus and further support the need for larger clinical trials.

Aprepitant in Anti-histamine-refractory Chronic Nodular Prurigo: A Multicentre, Randomized, Double-blind, Placebo-controlled, Cross-over, Phase-II trial (APREPRU)

“…In the past, the antipruritic effect of NK1 antagonism with aprepitant was demonstrated in mouse models (11,12) and in several case series in patients with acute and chronic pruritus (14)(15)(16)(17)(18)(19)(20)(21). The objective of this study was to confirm the antipruritic and symptom-alleviating effect of aprepitant 80 mg daily vs. placebo in patients with severe CP in CNPG.…”

“…In an NC/Nga mouse model, oral treatment with the NKR1-antagonist aprepitant, reduced the level of serum immunoglobulin E (IgE), tissue SP levels, and cutaneous infiltration of regulatory T cells (13). The clinical relevance of NKR1-antagonism in humans has been shown in several case series of acute and CP of various origin, using the inhibitor aprepitant (14)(15)(16)(17)(18)(19)(20)(21). In an open-label, not placebo-controlled proof-of-concept study, 20 patients with therapy-refractory CP of various origins experienced significant (p < 0.001) antipruritic effect within one week of monotherapy with aprepitant 80 mg once daily (22).…”

Aprepitant improves refractory pruritus in primary cutaneous T-cell lymphomas: experience of the Spanish Working Group on Cutaneous Lymphomas

“…Dear Editor , Aprepitant has shown promising anti‐itch activity in several cases of cutaneous T‐cell lymphoma (CTCL) . We sought to determine its antipruritic efficacy in a large multicentre series of patients with CTCL with refractory pruritus and, secondarily, to define possible clinical predictors of response.…”

Antipruritic vs. Antitumour Action of Aprepitant: A Question of Dose

“…In aprepitant-treated patients, the number of CD4 + PD-1-positive cells and plasma levels of soluble CD163 and SP decreased (11). Improvement in pruritus has been reported in patients with CTCL treated with aprepitant (Table I) (2,(12)(13)(14).…”