Evaluation of risk factors predictive of nausea and vomiting with current standard-of-care antiemetic treatment: analysis of two phase III trials of aprepitant in patients receiving cisplatin-based chemotherapy

Hesketh, Paul J.; Aapro, Matti; Street, James C.; Carides, Alexandra D.

doi:10.1007/s00520-009-0737-9

Cited by 148 publications

(114 citation statements)

References 15 publications

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“…On the other hand, it has been reported that younger age is one of the risks for the loss of emetic control (15-16, 18, 26-27). However, the cut-off value of age that influences the control of CINV remains unclear: poor control of CINV was reportedly associated with age under 55 years (19,26), age under 65 years (17,18), and age under 40 years (15). We reported very recently that in 608 patients receiving the first cycle of chemotherapy with any emetic risk, age under 50 years was significantly associated with high risk of CINV (OR=5.803, 95% CI=2.667-12.63; p<0.001) (21).…”

Section: Discussionmentioning

confidence: 99%

Control of Nausea and Vomiting in Patients with Colorectal Cancer Receiving Chemotherapy with Moderate Emetic Risk

Suzuki

Kobayashi

Fujii

et al. 2016

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Section: Discussionmentioning

confidence: 99%

Control of Nausea and Vomiting in Patients with Colorectal Cancer Receiving Chemotherapy with Moderate Emetic Risk

Suzuki

Kobayashi

Fujii

et al. 2016

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“…It is noteworthy, that addition of the NK 1 receptor antagonist, aprepitant, to a combination of ondansetron and dexamethasone, seemed to negate the adverse prognostic effect of female gender on the prevention of chemotherapy-induced vomiting. With addition of aprepitant 66% of women and 69% of men were protected from emesis and did not need rescue medication after cisplatin-based chemotherapy, whereas only 41% of women as compared to 53% of men were protected without aprepitant [17].The physiological or pharmacological mechanisms of such gender differences, for example the influence of hormonal status, would be worth exploration.…”

Section: Prognostic Factorsmentioning

confidence: 99%

Antiemetic research: future directions

Olver

Molassiotis

Aapro

et al. 2010

Support Care Cancer

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Purpose and methods As a part of reviewing the Multinational Association of Supportive Care in Cancer (MASCC) antiemetic guidelines in Perugia in 2009, an expert group identified directions for future antiemetic research. Results and conclusions In future trials, the prediction of nausea and vomiting may combine algorithms based on observed prognostic factors relating to the patient and the anticancer therapy, the identification of the genes that code for receptors, and pharmacogenetic studies of the metabolism of drugs. Design issues for future trials include standardising the emetic stimulus across studies and finding the minimum tolerated effective dose and schedule of an antiemetic. Also control of delayed emesis is not independent of the control of acute emesis. The full range of side effects and the impact on global quality of life scores should be part of the routine assessment of an antiemetic. With current high rates of control of acute vomiting, future trials will need to consider new primary endpoints such as nausea, a complex symptom, where improvement is needed. Economic endpoints should be incorporated to ascertain the cost benefit of antiemetic prophylaxis, taking into account the impact of nausea on work capacity. New antiemetic drugs may be targeted at different receptors, such as opioid, cannabinoid and peptide YY receptors. New research is needed into determining the extent of corticosteroid use. The emetic potential of a range of newer cytotoxics particularly when used in combinations and different scheduling, such as prolonged oral dosing of cytotoxics and use of targeted therapies, are all areas in need of research. More antiemetic studies are needed in niche areas such as in patients receiving high dose chemotherapy, radiation therapy or combined modality therapy. Further evidence of the efficacy of newer antiemetic agents is required in children.

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“…The same study by Hesketh et al [26] found a significant association between patients older than 65 years and CR (p = 0.021). A similar phase III trial of patients on AC by Warr et al [27] also noted a significant relationship between patients older than 55 years and CR (p = 0.006).…”

Section: Agementioning

confidence: 64%

“…A prospective study by Hesketh et al [26] evaluating the association between risk factors and CR from the data of 1043 patients in two identically designed phase III trials found that males (p = 0.023), but not females, was significantly associated with CR. This was also observed in our reviewed studies-a higher percentage of females tended towards poorer CINV control.…”

Section: Gendermentioning

confidence: 99%

Controlling Chemotherapy-Induced Nausea and Vomiting with Neurokinin-1 Receptor Antagonists in Patients on AC-Based Chemotherapy—Are We There Yet?

Yap¹,

Leong²,

Chan³

2012

JCT

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Chemotherapy-induced nausea and vomiting (CINV) are distressing side effects of chemotherapy. Neurokinin-1 receptor antagonists (NK1-RAs) have been incorporated in the contemporary management of CINV. However, clinical studies on NK1-RAs have shown mixed results in reducing CINV risk. Most studies focused on the use of aprepitant (APR) and casopitant (CAS) in breast cancer patients receiving AC-type (doxorubicin and cyclophosphamide) chemotherapy. In this study, we compared the study design and clinical efficacies of these NK1-RAs in reducing CINV risk. Among the selected eight studies, 4 APR Randomized Controlled Trials (RCTs), 2 APR Observational Studies (OSs) and 2 CAS RCTs were identified. Patient-related characteristics such as the proportion of females (60.0% -100.0%), age (46.5 -59.5 years), histories of motion (5.6% -47.0% in NK1-RA arms) and morning sicknesses (14.2% -45.0% in NK1-RA arms) and types of antiemetic regimens; as well as chemotherapy-related characteristics such as the proportion of patients on AC chemotherapy (15.0% -100.0%) varied greatly. In terms of efficacies, both APR and CAS improved overall CR and vomiting in majority of the studies. None of the studies, however, demonstrated that NK1-RA could provide adequate nausea control. To conclude, NK1-RAs are effective in improving vomiting and overall CR, but not useful in controlling nausea or attaining CC, the ideal CINV endpoint. A shift in paradigm is needed for future CINV research. As healthcare providers continue to strive for optimum CINV control in their patients, we hope this review can help them make better informed clinical decisions.

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Evaluation of risk factors predictive of nausea and vomiting with current standard-of-care antiemetic treatment: analysis of two phase III trials of aprepitant in patients receiving cisplatin-based chemotherapy

Abstract: This analysis confirmed the relevance of several previously reported risk factors for CINV in patients receiving chemotherapy. Aprepitant improved complete response regardless of risk and eliminated the increased risk of CINV associated with the female gender.

Cited by 148 publications

References 15 publications

Control of Nausea and Vomiting in Patients with Colorectal Cancer Receiving Chemotherapy with Moderate Emetic Risk

Control of Nausea and Vomiting in Patients with Colorectal Cancer Receiving Chemotherapy with Moderate Emetic Risk

Antiemetic research: future directions

Controlling Chemotherapy-Induced Nausea and Vomiting with Neurokinin-1 Receptor Antagonists in Patients on AC-Based Chemotherapy—Are We There Yet?

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