Control of Nausea Based on Risk Analysis in Patients with Esophageal and Gastric Cancer Who Received Cisplatin-based Chemotherapy

Abstract

Cisplatin is commonly used for esophageal and gastric cancer, however, the agent has high emetic risk, classified as highly emetic chemotherapy. Ohtsu et al. demonstrated in patients with advanced gastric cancer that 5-fluorouracil (5-FU) plus cisplatin led to a significantly higher tumor response rate and longer median progression-free survival but not overall survival as compared with 5-FU alone (1). Koizumi et al. also reported in phase 3 study comparing the effect of S-1 alone and its combination with cisplatin in patients with advanced gastric cancer that the combination was superior to S-1 alone in prolonging median progression-free survival (HR: 0.57; p<0.0001) as well as median overall survival (HR: 0.77; p=0.04) but led to more severe adverse drug reactions, including nausea and vomiting (2). Thus, oral fluoropyrimidine and cisplatin combination chemotherapy is currently used as the first-line treatment option for unresectable advanced gastric cancer. On the other hand, Bang et al. reported in patients with human epidermal growth factor receptor 2 (HER2)-positive gastric or gastro-oesophageal junction cancer that addition of trastuzumab (monoclonal antibody to HER2) to chemotherapy led to ignificantly longer median overall survival than chemotherapy alone (3). Thus, oral fluoropyrimidine, cisplatin and trastuzumab combination chemotherapy is currently regarded as the standard chemotherapy for HER2-positive gastric cancer.On the other hand, cisplatin with 5-FU regimen is recommended as neoadjuvant chemotherapy for stage II/III thoracic esophageal cancer and unresectable progressive recurrent esophageal cancer (4, 5).Cisplatin is classified as chemotherapy with high emetic risk (HEC) in several guidelines for prevention of chemotherapy-induced nausea and vomiting (CINV) (6-9). 6831

The efficacy of single dose palonosetron in highly emetogenic chemotherapy protocols compared to oral aprepitant and ondansetron

“…Furthermore, In a systematic review carried out by Mosa et al, it was reported that the risk of CINV is reduced by 4% with the increase of age by 1 year (Mosa, Hossain, Lavoie, & Yoo, 2020). Regarding gender, in many studies, women persistently had a higher risk of CINV than men (Fujii et al, 2017;Mosa et al, 2020;Sekine et al, 2013;Takemoto et al, 2017;Tamura et al, 2015;Tsuji et al, 2017;Uchida et al, 2017).…”

Distinct Nausea Profiles Are Associated With Gastrointestinal Symptoms in Oncology Patients Receiving Chemotherapy

“…Persistent CIN can lead to dehydration, nutritional deficits, decrements in quality of life, and even discontinuation of treatment. 4 Based on findings from cross-sectional studies, risk factors for CIN include age older than 60 years, [5][6][7] female gender, [6][7][8] lower functional status, 3 highly emetogenic chemotherapy regimens, 3,5,6,8 and higher serum albumin levels. 5 Although the occurrence of CIN during the first cycle of chemotherapy is a risk factor in future cycles, 4 only 4 longitudinal studies have evaluated for changes in the occurrence of CIN over time.…”

Prediction of chemotherapy-induced nausea and vomiting from patient-reported and genetic risk factors

“…Chemotherapy-induced nausea and vomiting (CINV) is one of the most common and feared side effects of cancer treatment [1, 2]. Despite use of modern prophylactic anti-emetic regimens according to international guidelines [3], up to 33% of patients treated with highly- or moderately-emetogenic chemotherapy experience one or more episodes of emesis and up to 62% experience nausea [4–6]. Patients experiencing CINV may be less likely to complete their prescribed chemotherapy regimen due to the significant impact of CINV on quality of life and activities of daily living [7, 8].…”