Chemotherapy-Induced Nausea and Vomiting in the Treatment of Gastrointestinal Tumors and Secondary Prophylaxis with Aprepitant

Abstract

Background: Chemotherapy-induced nausea and vomiting (CINV) belongs to the most feared side-effects of cancer treatment. Its incidence during chemotherapy of gastrointestinal tu-mors (GITs) with highly and moderately emetogenic regimens is not well documented. It is also unknown whether aprepitant, a neurokinin-1 receptor antagonist, can be used as secondary antiemetic prophylaxis in case of CINV during cycle 1. Patients and Methods: Patients with GITs who were treated with highly and moderately emetogenic chemotherapy received standard antiemetic prophylaxis including a 5-hydroxytryptamine-3 receptor antagonist and dexamethasone. In case of CINV > grade 1 (National Cancer Institute classification) during the first chemotherapy course, aprepitant was additionally administered with further cycles. Results: We screened 109 patients. 16 patients (15%) experienced acute and/or delayed CINV. Features associated with CINV were low-dose cisplatin-containing chemotherapy (15/16 patients), female gender (11/16 patients), abstinence to alcohol (11/16 patients) and former emesis gravidarum (11/16 patients). 11 patients who got further courses of the same chemotherapy received aprepitant. 7 are fully assessable for response. 5 of 7 patients had a complete protection from CINV (71%) and 1 patient had improved symptoms. Conclusions: In the majority of cases, primary standard antiemetic prophylaxis provided adequate protection against CINV. In case of failure to primary prophylaxis, secondary prophylaxis with aprepitant showed a high efficacy against CINV.

Risk factors at pretreatment predicting treatment-induced nausea and vomiting in Australian cancer patients: a prospective, longitudinal, observational study

“…Despite significant advances in antiemetic therapy with the introduction of serotonin (5-HT 3 ) and neurokinin (NK-1) receptor antagonists and prescriptive guidelines for their use, patients remain fearful [3,4] with almost 50% still experiencing NV during treatment (Table 1) [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17].…”

“…chemoradiation) that patients have increasingly received in recent years. Additionally, those examining chemotherapy-induced NV often did so after a single cycle rather than multiple cycles [25] and focused on moderately/highly emetogenic chemotherapy [12][13][14][15][16][17] to the exclusion of minimally/low emetogenic chemotherapy [25,30]. Finally, few published studies have investigated TINV outside of randomised controlled trial (RCT) settings [14,27].…”

The Difficult Trials

“…In a subpopulation (n = 123) treated with oxaliplatin-based chemotherapy, the 0-120-h complete response rate (no emesis and no need for rescue antiemetics) was improved from approximately 70% to approximately 80% by addition of casopitant. The three studies strongly suggest that patients treated with oxaliplatin-based chemotherapy need antiemetic prophylaxis for both acute and delayed nausea and vomiting [2,3]. A combination of a serotonin antagonist plus dexamethasone will provide sufficient antiemetic effect in the majority of patients [2][3][4], an effect that can be slightly improved by addition of the NK 1 -receptor antagonist casopitant [4].…”

“…The three studies strongly suggest that patients treated with oxaliplatin-based chemotherapy need antiemetic prophylaxis for both acute and delayed nausea and vomiting [2,3]. A combination of a serotonin antagonist plus dexamethasone will provide sufficient antiemetic effect in the majority of patients [2][3][4], an effect that can be slightly improved by addition of the NK 1 -receptor antagonist casopitant [4]. In the Abbrederis study, 11 patients with refractory nausea and vomiting in course one seemed to benefit from the addition of the NK 1 -receptor antagonist, aprepitant, in subsequent cycles of the same chemotherapy.…”

“…Clinical guidelines are therefore very specific and the level of evidence is high, when recommendations for antiemetic prophylaxis are given in patients treated with cisplatin-or AC-based chemotherapy [1]. The study by Abbrederis et al [2], published in this issue of OnkOlOgie is interesting because it included patients with cancer of the gastrointestinal tract -a study population rarely addressed in antiemetic trials. Furthermore a sub-population of patients with refractory emesis (emesis in the previous course of chemotherapy) was investigated, Abbrederis and colleagues found that the majority of patients (85%) obtained adequate antiemetic protection in cycle 1 with a regimen including a serotonin (5-HT) 3 -receptor antagonist (day 1) plus dexamethasone (day 1-3).…”