Aprepitant plus granisetron and dexamethasone for prevention of chemotherapy-induced nausea and vomiting in patients with gastric cancer treated with S-1 plus cisplatin

• Published in: Journal of gastroenterology Vol. 48; no. 11; pp. 1234 - 1241
• Main Authors: Oyama, Katsunobu, Fushida, Sachio, Kaji, Masahide, Takeda, Toshiya, Kinami, Shinichi, Hirono, Yasuo, Yoshimoto, Katsuhiro, Yabushita, Kazuhisa, Hirosawa, Hisashi, Takai, Yuki, Nakano, Tatsuo, Kimura, Hironobu, Yasui, Toshiaki, Tsuneda, Atsushi, Tsukada, Tomoya, Kinoshita, Jun, Fujimura, Takashi, Ohta, Tetsuo
• Format: Journal Article
• Language: English
• Published: Tokyo Springer Japan 01-11-2013; Springer; Springer Nature B.V
• Subjects: Abdominal Surgery; Aged; Aged, 80 and over; Antiemetics - adverse effects; Antiemetics - therapeutic use; Antineoplastic Combined Chemotherapy Protocols - adverse effects; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Aprepitant; Cancer; Cancer patients; Care and treatment; Chemotherapy; Cisplatin - administration & dosage; Colorectal Surgery; Dexamethasone; Dexamethasone - adverse effects; Dexamethasone - therapeutic use; Drug Combinations; Drug Therapy, Combination; Female; Gastroenterology; Granisetron - adverse effects; Granisetron - therapeutic use; Hepatology; Humans; Male; Medicine; Medicine & Public Health; Middle Aged; Morpholines - adverse effects; Morpholines - therapeutic use; Nausea; Nausea - chemically induced; Nausea - prevention & control; Neoplasm Staging; Original Article—Alimentary Tract; Oxonic Acid - administration & dosage; Prevention; Prospective Studies; Psychometrics; Quality of Life; Stomach cancer; Stomach Neoplasms - drug therapy; Stomach Neoplasms - pathology; Surgical Oncology; Tegafur - administration & dosage; Treatment Outcome; Vomiting - chemically induced; Vomiting - prevention & control; Aprepitant; CINV; Anorexia; Gastric cancer; QOL
• ISSN: 0944-1174; 1435-5922
• DOI: 10.1007/s00535-012-0746-1

Background
We aimed to evaluate the efficacy of a new combination antiemetic therapy comprising aprepitant, granisetron, and dexamethasone in gastric cancer patients undergoing chemotherapy with cisplatin and S-1.
Methods
Gastric cancer patients scheduled to receive their first course of chemotherapy with cisplatin (60 mg/m
2
) and S-1 (80 mg/m
2
) were treated with a new combination antiemetic therapy aprepitant, granisetron, and dexamethasone on day 1; aprepitant and dexamethasone on days 2 and 3; and dexamethasone on day 4. The patients reported vomiting, nausea, use of rescue therapy, and change in the amount of diet intake, and completed the Functional Living Index-Emesis (FLIE) questionnaire. The primary endpoint was complete response (CR; no emesis and use of no rescue antiemetics) during the overall study phase (0–120 h after cisplatin administration). The secondary endpoints included complete protection (CP; CR plus no significant nausea); change in the amount of diet intake; and the impact of chemotherapy-induced nausea and vomiting (CINV) on daily life during the overall, acute (0–24 h), and delayed (24–120 h) phases.
Results
Fifty-three patients were included. CR was achieved in 88.7, 98.1, and 88.7 % of patients in the overall, acute, and delayed phases, respectively. The corresponding rates of CP were 67.9, 96.2, and 67.9 %. Approximately half of the patients had some degree of anorexia. FLIE results indicated that 79.5 % of patients reported “minimal or no impact of CINV on daily life”.
Conclusions
Addition of aprepitant to standard antiemetic therapy was effective in gastric cancer patients undergoing treatment with cisplatin and S-1.