Among cancer patients receiving more than one nausea-inducing chemotherapy drug, the addition of the antiemesis drug Emend® (aprepitant) to standard antiemetic therapy reduced chemotherapy-induced nausea and vomiting, according to a study published in the journal Cancer.
Chemotherapy is often distressing for cancer patients due to severe nausea and vomiting. Despite significant progress over the past decade in managing chemotherapy-induced nausea and vomiting (CINV), more than half of all patients receiving chemotherapy still suffer from these side effects. Symptoms can be severely debilitating and often result in patients refusing further courses of chemotherapy. This minimizes chances for an optimal outcome.
Drugs to prevent nausea and vomiting (antiemetic drugs) can be given to patients before chemotherapy. Two classes of antiemetic drugs are 5-HT3-receptor antagonists and NK-1-receptor antagonists. These complementary classes of drugs take different approaches to preventing nausea and vomiting and may produce the best results when used in combination. The first 5-HT3-receptor antagonist, Zofran® (ondansetron) was FDA approved in January 1991 and has proved effective in controlling acute CINV (CINV that occurs in the first 24 hours after chemotherapy). The NK-1-receptor antagonist Emend was approved in March 2003 and reduces the probability of both acute and delayed CINV.
In order to determine whether CINV could be better controlled by adding Emend to a standard antiemetic regimen of Zofran plus a corticosteroid, researchers analyzed data from two phase III clinical trials. Study subjects were cancer patients scheduled to receive their first cisplatin-based chemotherapy regimen. Half of the subjects were given antiemetic therapy consisting of Emend, Zofran, and dexamethasone.
Control of nausea and vomiting was better in the group that received Emend. Over the five-day study period, 68% of patients treated with Emend, Zofran, and dexamethasone did not vomit, compared to 48% of those treated with Zofran and dexamethasone. The difference between study groups was more dramatic when the analysis was restricted to patients who, in addition to cisplatin, were also treated with the chemotherapy drugs doxorubicin or cyclophosphamide. Like cisplatin, doxorubicin and cyclophosphamide are known to cause nausea and vomiting in many patients. Among patients taking more than one nausea-inducing chemotherapy drug, 59% of patients treated with Emend, Zofran, and dexamethasone did not vomit, compared to 26% patients treated with Zofran and dexamethasone.
The researchers conclude that the addition of Emend to a standard entiemetic regimen results in better control of CINV, particularly among patients receiving more than one nausea-inducing chemotherapy drug. Patients who are about to start chemotherapy may wish to talk with their doctor about the best approaches to prevent CINV.
Reference: Gralla RJ, de Wit R, Herrstedt J et al. Antiemetic efficacy of the neurokinin-I antagonist, aprepitant, plus a 5HT3 antagonist and a corticosteroid in patients receiving anthracyclines or cyclophosphamide in addition to high-dose cisplatin. Cancer. 2005;104:864-8.
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