Abstract
Background
The aim of this study was to analyze the potential impact of chemotherapy-induced nausea and vomiting (CINV) on dose reductions, discontinuation of chemotherapy, and survival.
Patients and methods
This study was designed as individual participant data meta-analysis with the original study data of three phase II/III trials that were conducted by the North-Eastern German Society of Gynecological Oncology (NOGGO) including 1213 patients with recurrent ovarian cancer. Logistic and Cox regression analyses were used to estimate odds and hazard ratios after adjusting for age, ECOG, amount of delivered cycles, amount of recurrences, and amount of comedications and study.
Results
The majority of patients developed nausea (58.1%) and almost one third experienced vomiting (31.0%). CINV was not associated with FIGO stage, grading, histology, and number of recurrences. The necessity of dose reduction and discontinuation of chemotherapy did not correlate to nausea and vomiting (p = 0.88, p = 0.39 and p = 0.25, p = 0.54 respectively). Progression-free survival was shorter in patients with grade III/IV nausea and vomiting (p = 0.02; hazard ratio (HR) for grade III/IV nausea 1.58, 95% CI 1.14–2.20, and p = 0.02; HR for grade III/IV vomiting 1.67, 95% CI 1.15–2.42 respectively). CINV grade III/IV was also associated with poorer overall survival (p < 0.001; HR for grade III/IV nausea 2.35, 95% CI 1.64–3.37, and p < 0.001; HR for grade III/IV vomiting 1.67, 95% CI 1.15–2.42 respectively).
Conclusion
CINV is significantly associated with poorer prognosis in recurrent ovarian cancer patients while there was no correlation found with the necessity of dose reduction and prior discontinuation of treatment. This study underlines the importance of prevention and treatment of CINV as part of early best supportive care.
Similar content being viewed by others
References
Sun CC, Bodurka DC, Weaver CB, Rasu R, Wolf JK, Bevers MW, Smith JA, Wharton JT, Rubenstein EB (2005) Rankings and symptom assessments of side effects from chemotherapy: insights from experienced patients with ovarian cancer. Support Care Cancer 13:219–227
Havrilesky LJ, Alvarez Secord A, Ehrisman JA, Berchuck A, Valea FA, Lee PS, Gaillard SL, Samsa GP, Cella D, Weinfurt KP, Abernethy AP, Reed SD (2014) Patient preferences in advanced or recurrent ovarian cancer. Cancer. 120:3651–3659
Glaus A, Knipping C, Morant R, Böhme C, Lebert B, Beldermann F, Glawogger B, Ortega PF, Hüsler A, Deuson R (2004) Chemotherapy-induced nausea and vomiting in routine practice: a European perspective. Support Care Cancer 12:708–715
Gilmore JW, Peacock NW, Gu A, Szabo S, Rammage M, Sharpe J, Haislip ST, Perry T, Boozan TL, Meador K, Cao X, Burke TA (2014) Antiemetic guideline consistency and incidence of chemotherapy-induced nausea and vomiting in US community oncology practice: INSPIRE study. J Oncol Pract 10:68–74
Sehouli J, Stengel D, Harter P, Kurzeder C, Belau A, Bogenrieder T, Markmann S, Mahner S, Mueller L, Lorenz R, Nugent A, Wilke J, Kuznik A, Doering G, Wischnik A, Sommer H, Meerpohl H-G, Schroeder W, Lichtenegger W, Oskay-Oezcelik G (2011) Topotecan weekly versus conventional 5-day schedule in patients with platinum-resistant ovarian cancer: a randomized multicenter phase II trial of the North-Eastern German Society of Gynecological Oncology Ovarian Cancer Study Group. J Clin Oncol 29:242–248
Sehouli J, Stengel D, Oskay-Oezcelik G, Zeimet AG, Sommer H, Klare P, Stauch M, Paulenz A, Camara O, Keil E, Lichtenegger W (2008) Nonplatinum topotecan combinations versus topotecan alone for recurrent ovarian cancer: results of a phase III study of the North-Eastern German Society of Gynecological Oncology Ovarian Cancer Study Group. J Clin Oncol 26:3176–3182
Sehouli J, Chekerov R, Reinthaller A, Richter R, Gonzalez-Martin A, Harter P, Woopen H, Petru E, Hanker LC, Keil E, Wimberger P, Klare P, Kurzeder C, Hilpert F, Belau AK, Zeimet A, Bover-Barcelo I, Canzler U, Mahner S, Meier W (2016) Topotecan plus carboplatin versus standard therapy with paclitaxel plus carboplatin (PC) or gemcitabine plus carboplatin (GC) or pegylated liposomal doxorubicin plus carboplatin (PLDC): a randomized phase III trial of the NOGGO-AGO-Study Group-AGO Austria and GEICO-ENGOT-GCIG intergroup study (HECTOR). Ann Oncol 27:2236–2241
Jordan K, Jahn F, Aapro M (2015) Recent developments in the prevention of chemotherapy-induced nausea and vomiting (CINV): a comprehensive review. Ann Oncol Off J Eur Soc Med Oncol 26:1081–1090
Aapro M, Molassiotis A, Dicato M, Peláez I, Rodríguez-Lescure Á, Pastorelli D, Ma L, Burke T, Gu A, Gascon P, Roila F, PEER investigators (2012) The effect of guideline-consistent antiemetic therapy on chemotherapy-induced nausea and vomiting (CINV): the Pan European Emesis Registry (PEER). Ann Oncol 23:1986–1992
Molassiotis A, Saunders MP, Valle J, Wilson G, Lorigan P, Wardley A, Levine E, Cowan R, Loncaster J, Rittenberg C (2008) A prospective observational study of chemotherapy-related nausea and vomiting in routine practice in a UK cancer centre. Support Care Cancer Off J Multinatl Assoc Support Care Cancer 16:201–208
Yu S, Burke TA, Chan A, Kim H-K, Hsieh RK, Hu X, Liang J-T, Baños A, Spiteri C, Keefe DMK (2015) Antiemetic therapy in Asia Pacific countries for patients receiving moderately and highly emetogenic chemotherapy—a descriptive analysis of practice patterns, antiemetic quality of care, and use of antiemetic guidelines. Support Care Cancer Off J Multinatl Assoc Support Care Cancer 23:273–282
King MT, Stockler MR, O’Connell RL, Buizen L, Joly F, Lanceley A, Hilpert F, Okamoto A, Aotani E, Bryce J, Donnellan P, Oza A, Avall-Lundqvist E, Berek JS, Sehouli J, Feeney A, Berton-Rigaud D, Costa DSJ, Friedlander ML, GCIG Symptom Benefit Group (2018) Measuring what matters MOST: validation of the Measure of Ovarian Symptoms and Treatment, a patient-reported outcome measure of symptom burden and impact of chemotherapy in recurrent ovarian cancer. Qual Life Res 27:59–74
Acknowledgements
Parts of the results have been chosen for abstract publication related to the ASCO 2017: Woopen H, Richter R, Inci G, Chekerov R, Oskay-Oezcelik G, Sehouli J. The influence of chemotherapy-induced nausea and vomiting (CINV) on survival: an individual participant data meta-analysis of the North-Eastern German Society of Gynecological Oncology (NOGGO) of 1213 recurrent ovarian cancer patients. J Clin Oncol 35, 2017 (suppl; abstr e17062).
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
Prof. Sehouli has received research funding from GlaxoSmithKline. Dr. Hannah Woopen, MSc was a participant in the Charité Clinical Scientist Program funded by the Charité Universitätsmedizin Berlin and the Berlin Institute of Health.
Additional information
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Woopen, H., Richter, R., Chekerov, R. et al. Prognostic role of chemotherapy-induced nausea and vomiting in recurrent ovarian cancer patients: results of an individual participant data meta-analysis in 1213. Support Care Cancer 28, 73–78 (2020). https://doi.org/10.1007/s00520-019-04778-1
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00520-019-04778-1