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Prophylactic aprepitant is better than salvage for carboplatin-based chemotherapy: a propensity score-matched analysis

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Abstract

Aprepitant prevents chemotherapy-induced nausea and vomiting (CINV) in carboplatin-containing chemotherapy. However, it is unknown whether aprepitant salvage therapy after the development of emesis is as effective as adding prophylactic aprepitant to doublet therapy with dexamethasone and a 5-HT3 receptor antagonist from the first cycle of chemotherapy. To compare the antiemetic efficacy of aprepitant between salvage and prophylactic administration in the second cycle of carboplatin-containing chemotherapy, twenty-two NSCLC patients who developed CINV in the first cycle of carboplatin-containing therapy without aprepitant (salvage group) and 44 patients who received aprepitant (prophylaxis group) were extracted from the pooled data of two clinical trials, with adjustment for age, sex, and chemotherapeutic regimen as co-variables using propensity score matching. In the second cycle of chemotherapy, both groups received aprepitant, and the rate of antiemetic complete response (no vomiting and no rescue therapy) at 5 days after chemotherapy was compared. The prophylaxis group demonstrated a significantly better overall complete response rate (88.6%; 95% confidence interval [CI] 75.4–96.2) compared with that of observed for the salvage group (68.2%; 95% CI 45.1–86.1, p = 0.042). The prophylaxis group also demonstrated a significantly lower proportion of any-grade nausea (43.2%) and appetite loss (43.2%) than the salvage group (72.7%, p = 0.036 and 77.3%, p = 0.010, respectively). Adding aprepitant to doublet therapy from the first cycle of carboplatin-containing chemotherapy may be more effective than salvage use of aprepitant after the development of CINV.

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Acknowledgements

We thank James P. Mahaffey, PhD, from Edanz Group (http://www.edanzediting.com/ac) for editing a draft of this manuscript.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, 1-20-1 Handayama, Hamamatsu, 431-3192, Japan

    Masato Karayama, Naoki Inui, Kazuki Tanaka, Hideki Yasui, Hironao Hozumi, Yuzo Suzuki, Kazuki Furuhashi, Tomoyuki Fujisawa, Noriyuki Enomoto, Yutaro Nakamura & Takafumi Suda

  2. Department of Clinical Oncology, Hamamatsu University School of Medicine, 1-20-1 Handayama, Hamamatsu, 431-3192, Japan

    Masato Karayama

  3. Department of Clinical Pharmacology and Therapeutics, Hamamatsu University School of Medicine, 1-20-1 Handayama, Hamamatsu, 431-3192, Japan

    Naoki Inui

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  1. Masato Karayama
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Correspondence to Naoki Inui.

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All procedures performed in the study were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Karayama, M., Inui, N., Tanaka, K. et al. Prophylactic aprepitant is better than salvage for carboplatin-based chemotherapy: a propensity score-matched analysis. Med Oncol 35, 139 (2018). https://doi.org/10.1007/s12032-018-1199-z

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  • DOI: https://doi.org/10.1007/s12032-018-1199-z

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