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Palonosetron plus 3-day aprepitant and dexamethasone to prevent nausea and vomiting in patients receiving highly emetogenic chemotherapy

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Abstract

Background

The combination of a neurokinin-1 receptor antagonist, dexamethasone, and a 5-HT3 receptor antagonist is currently the standard antiemetic treatment in patients receiving cisplatin-based high emetogenic chemotherapy (HEC). The aim of this study was to evaluate the efficacy of a combination of palonosetron, a unique second-generation 5-HT3 receptor antagonist, aprepitant, the only approved neurokinin-1 receptor antagonist, and dexamethasone as antiemetic prophylaxis in patients receiving HEC (cisplatin ≥50 mg/mq).

Methods

Chemotherapy-naïve adult patients, receiving cisplatin-based HEC, were treated with palonosetron 0.25 mg/i.v., dexamethasone 20 mg/i.v., and aprepitant 125 mg/p.o., 1-h before chemotherapy. Aprepitant 80 mg/p.o. and dexamethasone 4 mg p.o. were administered on days 2–3. Primary end point was complete response (CR; no vomiting and no use of rescue medication), during the overall study period (0–120 h). Secondary end points were complete control (CR and no more than mild nausea), emesis-free rate, and nausea-free rate during the acute (0–24 h), delayed (24–120 h), and overall (0-120 h) periods. Safety was also evaluated.

Results

A total of 222 patients were included in the study. Median age was 62 years, 76.6% were male and 23.4% female, and most common tumors were lung (66.7%) and head and neck (15.8%); 70.3% of patients achieved CR during the overall study period. Complete control, emesis-free rate, and nausea-free rate were 70.3%, 92.8%, and 59.9%, respectively, during the overall phase. The most commonly reported side effects were constipation (39% of patients) and headache (5%).

Conclusions

This study shows that palonosetron in combination with aprepitant and dexamethasone is effective to prevent chemotherapy-induced nausea and vomiting in patients treated with cisplatin-based HEC.

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Authors and Affiliations

  1. Department of Clinical Oncology A, “Sapienza” University of Rome, Policlinico Umberto Primo, Rome, Italy

    Flavia Longo, Vittoria Lapadula, Rita De Sanctis, Silvia Quadrini, Bruno Gori, I. D’Antoni, Ester Del Signore, Luciano Stumbo, Cristina De Luca & Marisa Di Seri

  2. U.O.C. Clinical Oncology, Ospedale Umberto Primo, Frosinone, Italy

    Giovanni Mansueto, Roberta Grande & Teresa Gamucci

  3. Department of Clinical Oncology B, “Sapienza” University of Rome, Policlinico Umberto Primo, Rome, Italy

    Amelia Altavilla, Barbara Cimadon & Enrico Cortesi

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  1. Flavia Longo
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  2. Giovanni Mansueto
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  3. Vittoria Lapadula
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  15. Teresa Gamucci
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Correspondence to Flavia Longo.

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Longo, F., Mansueto, G., Lapadula, V. et al. Palonosetron plus 3-day aprepitant and dexamethasone to prevent nausea and vomiting in patients receiving highly emetogenic chemotherapy. Support Care Cancer 19, 1159–1164 (2011). https://doi.org/10.1007/s00520-010-0930-x

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  • DOI: https://doi.org/10.1007/s00520-010-0930-x

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