Aprepitant and Fosaprepitant Use in Children and Adolescents at an Academic Medical Center

Abstract

OBJECTIVE: To describe the use of aprepitant and fosaprepitant, a neurokinin 1 (NK-1) receptor inhibitor, in children and adolescents at a large academic medical center, for the prevention and management of chemotherapy-induced nausea and vomiting (CINV). METHODS: A retrospective chart review was conducted using an electronic medical record system to evaluate the use of aprepitant and fosaprepitant in all pediatric patients that were discharged from a single academic medical center between February 25, 2009 and May 25, 2012. RESULTS: Twenty-six patients were included in this review and received a total of 287 doses over the span of 114 cycles. Mean age was 10.1 years, with a range of 11 months to 17 years old. In 16 of 26 patients, aprepitant was used as the primary prophylaxis. Of those patients who received primary prophylaxis, 6 of 16 received it for highly emetogenic chemotherapy, and 10 of 16 received it for moderately emetogenic chemotherapy. Intravenous fosaprepitant was used in 7 of 26 patients, ages 13 to 17 (median 14) years old. No adverse effects attributable to aprepitant were reported. CONCLUSIONS: Use of aprepitant and fosaprepitant in pediatric patients appeared to be well tolerated. No currently published reports data using aprepitant in a patient younger than 32 months old, whereas we reported its use in patients as young as 11 months old.

Intravenous fosaprepitant for the prevention of chemotherapy‐induced vomiting in children: A double‐blind, placebo‐controlled, phase III randomized trial

“…The study found fosaprepitant to be safe . Another retrospective study of seven patients who received fosaprepitant prophylaxis for prevention of CINV did not report any adverse events …”

“…23 Another retrospective study of seven patients who received fosaprepitant prophylaxis for prevention of CINV did not report any adverse events. 24 RCTs have shown that the addition of aprepitant to ondansetron with or without dexamethasone improved CR rates in children receiving MEC or HEC. 12,20 Bakhshi et al reported significant improvement in CR rates with the addition of aprepitant during the acute phase (48% vs 12 %, P < 0.001).…”

Guideline for the Treatment of Breakthrough and the Prevention of Refractory Chemotherapy‐Induced Nausea and Vomiting in Children With Cancer

“…[30][31][32][33][34][35] Published experience with fosaprepitant in children is limited. [36] This recommendation places a high value on improved CINV control when control is likely to be difficult to achieve and on the negative consequences of uncontrolled CINV. It is a weak recommendation since direct evidence of the efficacy of aprepitant in this context is lacking.…”

Antiemetic prophylaxis with fosaprepitant and granisetron in pediatric patients undergoing allogeneic hematopoietic stem cell transplantation

“…The development of new or optimization of existing antiemetic prophylaxis strategies is therefore urgently needed to improve these patients' quality of life and their treatment outcome. Although the newly available NK 1 -receptor antagonist fosaprepitant has shown a favorable antiemetic efficacy in children undergoing moderately or highly emetogenic chemotherapy (Radhakrishnan et al 2018;Saito et al 2019;Shillingburg and Biondo 2014;Timaeus et al 2018), its use for pediatric patients is not yet proposed by international guidelines (Dupuis et al 2013(Dupuis et al , 2017. Study data on fosaprepitant in children undergoing HSCT are currently not available.…”