The NK-1 receptor-antagonist aprepitant in high-dose chemotherapy (highdose melphalan and high-dose T-ICE: paclitaxel, ifosfamide, carboplatin, etoposide): efficacy and safety of a triple antiemetic combination

Abstract

Complete protection from nausea/vomiting is currently achieved in a minority of patients receiving high-dose chemotherapy (HDC). Currently the use of 5-HT 3 -antagonists and dexamethasone (DEX) represents the standard of care. The role of the NK-1-antagonist aprepitant in HDC remains to be better defined. A total of 64 patients undergoing multiple days of HDC received granisetron, DEX plus aprepitant during chemotherapy. After the end of chemotherapy aprepitant plus DEX was given for a further 2 days. Primary end point was CR defined as no vomiting and no use of rescue medication in the overall phase (day 1 until 5 days after end of chemotherapy). Acute/delayed and overall CR were achieved in 83%/70% and 63%, respectively. Acute and delayed nausea were observed in 20 and 38% of the patients. The tolerability of the aprepitant regimen over 4-5 days was comparable with the 3-day antiemetic regimen. In our study, aprepitant demonstrated good tolerability. Taking into account the methodological constraints of comparing our results with those from the available literature, the addition of aprepitant to the antiemetic treatment regimen may provide improved prevention of chemotherapy-induced nausea and vomiting during HDC.

A randomized controlled study evaluating the efficacy of aprepitant for highly/moderately emetogenic chemotherapies in hematological malignancies

“…Detailed analysis of this group indicated that all of the subjects suffered from delayed phase CINV. This is different from the previous reports that aprepitant-containing prophylaxis achieved successful prevention of CINV in 60-80 % of patients receiving the transplantation regimens [10,11]. One possible reason for this discrepancy would be the difference of administration duration of aprepitant.…”

“…Thus, the effectiveness of aprepitant to prevent CINV in the settings without dexamethasone use should be assessed. Until now, several studies have demonstrated the benefit of incorporating aprepitant in antiemetic regimens for conditioning regimens for hematopoietic stem cell transplantation [10][11][12]. However, evidence for aprepitant administration as antiemetic prophylaxis in conventional chemotherapies for hematological malignancies is lacking.…”

Antiemetic effectiveness and safety of aprepitant in patients with hematologic malignancy receiving multiday chemotherapy

“…19 The results of several studies have confirmed the antiemetic effect and safety of aprepitant in combination with a 5-HT 3 antagonist and dexamethasone for patients taking multiday chemotherapy. [20][21][22][23][24] However, the usefulness of aprepitant in patients receiving multiday chemotherapy for hematologic malignancies remains unclear. Compared with chemotherapy regimens for patients with solid tumors, more anticancer regimens for patients with hematologic malignancies are delivered over multiple days.…”

Clinical Impact of Aprepitant in Patients Receiving High-Dose Chemotherapy prior to Autologous Peripheral Blood Stem Cell Transplantation: A Cost-Effectiveness Analysis

“…A number of patients receiving HDCT and APBSCT still experienced uncontrollable CINV [6,7] . Several prospective studies have reported the antiemetic effect of aprepitant for HDCT prior to APBSCT [13][14][15][16][17] . Nevertheless, the ASCO guidelines recommended the use of a 5-HT3 receptor antagonist plus dexamethasone in patients treated with HDCT and indicate that aprepitant "should be considered" for prophylaxis of CINV [8,9] .…”

“…Some studies have reported that the use of aprepitant was effective for CINV prophylaxis prior to HDCT and APBSCT [13][14][15][16][17] . However, the cost benefit of aprepitant was not evaluated in those reports.…”