A Nationwide, Multicenter Registry Study of Antiemesis for Carboplatin-Based Chemotherapy-Induced Nausea and Vomiting in Japan

Abstract

Background. We previously reported the results of a prospective study of chemotherapy-induced nausea and vomiting (CINV) in a cohort of patients who received carboplatin-based chemotherapy and were selected from a nationwide registry of those scheduled for moderately (MEC) or highly emetogenic chemotherapy (HEC) by the CINV Study Group of Japan. Of 1,910 previously registered patients (HEC: 1,195; MEC: 715), 400 patients received carboplatin-based chemotherapy. The frequency of CINV was determined, and the risk factors for CINV were assessed. Materials and Methods. CINV data were collected from 7-day diaries. Risk factors for CINV were identified using logistic regression models. Results. Of 400 patients scheduled for carboplatin-based chemotherapy, 267 patients received two antiemetics (5-hydroxytryptamine-3 receptor antagonist [5-HT 3 RA] and dexamethasone [DEX]), 118 patients received three antiemetics (5-HT 3 RA, DEX, and neurokinin-1 receptor antagonist [NK 1 RA]), and 15 were nonadherent to the treatment. In these patients, the CINV overall, acute, and delayed phase rates of complete response (CR), defined as no vomiting with no rescue medication, were 67.0%, 98.2%, and 67.5%, respectively. The rates of no nausea were 55.6%, 94.0%, and 56.1%, respectively, and those of no vomiting were 81.3%, 99.0%, and 81.8%, respectively. Older age was associated with a decreased non-CR, whereas female sex, history of pregnancy-related emesis, and dual antiemetic therapy were associated with an increased non-CR during the overall period. Conclusion. In a clinical practice setting, in patients who received carboplatin-based chemotherapy, adherence is quite high and appropriate antiemetic prophylaxis requires a triple antiemetic regimen including NK 1 RA. The Oncologist 2020;25: e373-e380 Implications for Practice: For patients receiving carboplatin-based chemotherapy, triple antiemetic therapy with 5-hydroxytryptamine-3 receptor antagonist, dexamethasone, and neurokinin-1 receptor antagonist should be given prophylactically regardless of risk factor status. Correspondence: Hirotoshi Iihara, Ph.D.Antiemesis in Carboplatin-Treated Patients e376 Lung (n = 216) 154 (71.3) 213 (98.6) 156 (72.2) 136 (63.0) 204 (94.4) 137 (63.4) 185 (85.7) 213 (98.6) 188 (87.0) Abbreviation: 5HT 3 RA, 5-hydroxytryptamine-3 receptor antagonist.

Low-Dose Olanzapine Plus Granisetron and Dexamethasone for Carboplatin-Induced Nausea and Vomiting in Patients with Thoracic Malignancies: A Prospective Multicenter Phase II Trial

“…Thus, 5 mg of OLZ might be more effective than adding NK 1 RA because of a high CR rate of 94.0%. We also found that the highest incidence of nausea and vomiting was on days 3–4, consistent with a previous report of two‐ or three‐drug combinations for CBDCA [34]. Therefore, it is necessary to closely monitor the onset of nausea and vomiting on days 3–4, despite administration of OLZ.…”

Low Dose Olanzapine in the Prevention Carboplatin Induced Nausea and Vomiting: a Prospective Randomized Controlled Trial

“…The hypothesis of this study was that the TC rate of 5 mg OZL in triplet group would be signi cantly higher than that of standard group. Other trials have shown that the TC rate of standard antiemetic therapy was about 40% [13] .We believed that an improvement of more than 15% in the TC rate would be clinically meaningful. Therefore, assuming that the null hypothesis of the TC rate is 55% and the alternative hypothesis is 80%, we calculated that a minimum of 90 patients were required to achieve a one-sided type I error of 0.1% and 80% of power, based on the exact binomial distribution.…”

Incidence of Chemotherapy-Induced Nausea and Vomiting and Antiemetic Guideline Compliance in Chinese Real Clinical Setting: A Cross-Sectional Multicenter Survey

“…In this study, only 13.6% of patients prescribed HEC and 35.7% of patients prescribed MEC complied the NCCN 2019 guidelines, respectively, which were comparable with the results reported in the conducted by Aapro et al (11%, 39%, respectively). However, this was not a satisfactory result when compared with the GCCP prevalence in a Japanese study, in which Hirotoshi et al reported 96% of patients receiving carboplatin-based chemotherapy (HEC and MEC were both included) were in compliance with the antiemesis guidelines based on JSCO 2010 guidelines [14]. Except the fact of using different guidelines, Japan enacted the rst cancer control law in 2006, which con rmed that political policies could in uence compliance with guidelines [14].…”