EMEMND FOR MODERATE EMETOGENIC REGIMENS

NEW YORK (Reuters Health) Aug 09 - Adding aprepitant to anti-emesis treatment seems to reduce nausea and vomiting among patients who are likely to experience it during moderately emetogenic chemotherapy, according to a Japanese paper.

It wasn't significantly better than placebo with dexamethasone, however.

"Chemotherapy agents are important for measuring the emetic-risk, however, patient characteristics are also important," lead investigator Dr. Maki Tanioka told Reuters Health in an email.

In a report online in British Journal of Cancer July 16, Dr. Tanioka, from the Hyogo Cancer Center in Akashi, and his colleagues explain that the risk of chemotherapy-induced nausea and vomiting is related to gender and age. "Female and younger patients are at greater risk. In contrast, patients with a history of heavy alcohol consumption have a lower risk."

The team investigated the value of aprepitant in 94 nondrinking women younger than 70 years being treated for cancer, mainly ovarian or endometrial cancer. Most received carboplatin-based chemotherapy, which is classified as moderately emetogenic.

The patients were randomly assigned to receive aprepitant or placebo one hour before chemo infusion and on days 2 and 3. All the patients received granisetron on day 1 and dexamethasone on days 1-3, but with a higher dose given to the placebo group.

Complete response was defined as no vomiting or retching episodes and no use of rescue medication.

In the acute phase (day 1), the complete response rate was high in both the aprepitant and placebo arms at 97.8% and 95.7%, respectively. During the delayed phase (days 2-5), however, the overall response rate was "superior but not significantly higher" in the aprepitant group (62.2%) than the placebo group (52.1%; p=0.33), the team reports.

The authors conclude, "Addition of aprepitant seemed to be effective even with an increased dose of dexamethasone; however, improvement is required in the delayed phase CR (complete response) rate."

However, they say the non-significant difference of 10 percentage points was "lower than our initial expectation of 20%." In his email, Dr. Tanioka added, "Larger clinical studies would be needed to address the significance of aprepitant for the high-emetic risk patients such as women, young patients, and non-drinkers."

SOURCE: http://bit.ly/1czX312

Br J Cancer 2013.