Supportive Care in Cancer

, Volume 20, Issue 10, pp 2357–2361

Using aprepitant as secondary antiemetic prophylaxis for cancer patients with cisplatin-induced emesis

Original Article

DOI: 10.1007/s00520-011-1345-z

Cite this article as:
Wu, CE. & Liaw, CC. Support Care Cancer (2012) 20: 2357. doi:10.1007/s00520-011-1345-z

Abstract

Purpose

Chemotherapy-induced emesis remains a problem despite prophylaxis with 5-hydroxytryptamine (5-HT3) antagonists and dexamethasone. The purpose of the current study was to evaluate the efficacy of adding aprepitant, a neurokinin-1(NK-1) receptor antagonist, as a secondary antiemetic prophylaxis in cases failing to achieve full protection against emesis during the first cycle of a cisplatin-based regimen.

Methods

Patients receiving chemotherapy with a dose of at least 50 mg/m2 of cisplatin-based regimens were eligible. If patients failed to achieve complete protection against vomiting when antiemetics (5-HT3 antagonists and dexamethasone) were given in cycle 1, aprepitant was added in subsequent cycles. The primary endpoint was complete response (no emetic episodes and no rescue antiemetics) during days 1–6.

Results

We analyzed 257 patients consecutively. Forty-nine patients (19%) had acute and/or delayed emesis during the first cycle of chemotherapy. Forty of 49 patients received aprepitant for secondary prophylaxis of emesis in the second cycle. Complete protection from vomiting and nausea was achieved in 63% and 55% of patients, respectively. Thirty-five patients received aprepitant for the third cycle. Complete protection from vomiting and nausea was achieved in 77% and 71% of patients, respectively.

Conclusions

Primary antiemetic prophylaxis with 5-HT3 antagonists plus dexamethasone provided more than 80% complete protection against cisplatin-induced emesis. Addition of aprepitant as secondary antiemetic prophylaxis in subsequent cycles provided adequate emesis protection in patients who failed primary prophylaxis. Using aprepitant as secondary antiemetic prophylaxis for cancer patients with cisplatin-induced emesis is feasible and cost-effective.

Keywords

Aprepitant NK-1 receptor antagonist Cisplatin Chemotherapy Antiemesis Secondary prophylaxis 

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  1. 1.Division of Hematology-Oncology, Department of Internal MedicineChang Gung Memorial Hospital at Linkou, Chang Gung University College of MedicineTaoyuan CountyTaiwan

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