Efficacy of triple antiemetic therapy (palonosetron, dexamethasone, aprepitant) for chemotherapy-induced nausea and vomiting in patients receiving carboplatin-based, moderately emetogenic chemotherapy

Abstract

BackgroundChemotherapy-induced nausea and vomiting (CINV) is a major adverse toxicity of cancer chemotherapy. Recommended treatments for prevention of CINV vary among published guidelines, and optimal care for CINV caused by moderately emetogenic chemotherapy has not been established. This study assessed the efficacy and safety of triple antiemetic therapy comprising palonosetron, dexamethasone and aprepitant for carboplatin-based chemotherapy. Chemotherapy-naïve patients with lung cancer scheduled for a first course of a carboplatin-containing regimen formed the study cohort. Patients were pretreated with antiemetic therapy comprising palonosetron (0.75 mg, i.v.) and dexamethasone (9.9 mg, i.v.) on day 1, and aprepitant (125 mg, p.o.) on day 1 followed by 80 mg on days 2 and 3. Primary endpoint was the proportion of patients who did not experience vomiting and did not require rescue medication [complete response (CR)] in the acute phase (0–24 h), late phase (24–168 h) and overall. Secondary endpoint was the proportion of patients who experienced no vomiting episodes and no more than mild nausea without the need for rescue medication [complete control (CC)].ResultsPrevalence of a CR during the acute phase, delayed phase, and overall was 100, 91.9 and 91.9%, whereas that of CC was 100, 84.4 and 84.4%, respectively. The most common adverse event was mild constipation; severe adverse events related to antiemetic treatment were not observed.ConclusionTriple antiemetic therapy comprising palonosetron, dexamethasone and aprepitant shows excellent effects in the prevention of CINV in patients receiving a carboplatin-containing regimen.

Metformin partially reverses the carboplatin-resistance in NSCLC by inhibiting glucose metabolism

“…Carboplatin is one representative platinum-based chemotherapeutic drug. It exhibits effective activity against various solid tumors, especially NSCLC [ 19 , 20 ]. Survival time of NSCLC patients is usually linked to the degree of clinical response to carboplatin treatment [ 21 , 22 ].…”

Use of dexamethasone and a 5-HT3 receptor antagonist with or without aprepitant to prevent chemotherapy-induced nausea and vomiting among patients with lung cancer who are treated with platinum-based chemotherapy: a systematic review and meta-analysis of randomized controlled trials

“…Our meta-analysis showed that ADH is superior to DH in terms of a better overall CR and overall NNR, as suggested that ADH led to a better CR and NNR, but the differences were not significant. Some studies also showed similar results in patients with different cancers who received different chemotherapy regimens and were of different ages (8,23). We propose two likely explanations for the results: (I) 5-HT3 RA combined with 5-HT3 (a major pathogenic factor in acute CINV) is effective for the acute CR and NNR; aprepitant is an NK-1 RA, mainly for substance P (major pathogenic factor in delayed CINV), which predominates in the delayed phase to improve the CR and NNR.…”

“…Two included RCTs (13,14) showed a better CR and NNR in the ADH group, but the differences were not significant. Albany et al (22) and Miya et al (8) reported that the ADH group had an effective CR and NNR after treatment with two different chemotherapy regions (cisplatin and carboplatin). We propose several explanations for these findings.…”

“…Aprepitant is a neurokinin-1 (NK-1) RA that functions in both the gut and the central nervous system by antagonizing the interaction of substance P (chemotherapyrelated increase) and NK-1 receptors to prevent CINV (7). Some clinical trials have suggested that adding aprepitant (ADH) to DH has achieved excellent effects (8). However, researchers have not clearly determined whether ADH is better than DH at preventing CINV in patients with LC (9,10).…”

The role of pyruvate kinase M2 in anticancer therapeutic treatments (Review)

“…Carboplatin is also a platinum-based chemotherapeutic drug. It is an effective treatment for various solid tumor types, particularly non-small cell lung cancer (NSCLC) (81). However, NSCLC cells commonly develop resistance following carboplatin treatment (82).…”