Author of

• 11001

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  P1.24 - Poster Session 1 - Clinical Care (ID 146)

  • Event: WCLC 2013
  • Type: Poster Session
  • Track: Supportive Care
  • Presentations: 1
  • Moderators:
  • Coordinates: 10/28/2013, 09:30 - 16:30, Exhibit Hall, Ground Level

  • 11020

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    P1.24-019 - Therapeutic and preventive effects of aprepitant for chemotherapy-induced nausea and vomiting in Japanese patients with thoracic malignancies (ID 1510)

    09:30 - 09:30  |  Author(s): I. Tsukiyama
    • Abstract

    Background
    Neurokinin-1 receptor antagonist (NK1RA) in addition to 5-hydroxytryptamine receptor antagonists (5HT3RA) and dexamethasone (Dex) is recommended for chemotherapy-induced nausea and vomiting (CINV) in highly emetogenic chemotherapy (HEC). It had been also reported that 40-60% of patients receiving HEC had not experienced significant nausea and/or vomiting before NK1RA became available. In 2010 NK1RA aprepitant was introduced for CINV prophylaxis in Japan. However, what proportion of patients receiving emetogenic chemotherapy need NK1RA, and whether all patients undergoing HEC truly need NK1RA remain unknown. Increasing medical costs due to uniform use of NK1RA is another concern. The primary objective of this study is the prevalence of patients who require aprepitant. Therapeutic and preventive effects of aprepitant on CINV induced by HEC or moderately emetogenic chemotherapy (MEC), and quality of life (QOL) regarding CINV are secondary objectives. We conducted this single-institute study before fully introducing aprepitant into clinical practice in our institute.

    Methods
    From July 2011 to January 2013, 96 consecutive patients receiving HEC or MEC, with age ≥ 20, able to use Japanese language, and with written informed consent, were enrolled onto the study, and 77 patients were analyzed who received ≥ 2 courses in the same chemotherapy regimen. 5-HT3RA and Dex were administered to prevent CINV. Aprepitant was administered to treat CINV in the first course when CINV occurred, or administered to prevent CINV in the second course. All patients who experienced CINV in the first course received prophylactic aprepitant from the second course. QOL regarding CINV was assessed by Functional Living Index of Emesis (FLIE). Numerical rating scale (NRS) was used to assess the severity of nausea. This study was approved by the Institutional Review Board of Aichi Medical University.

    Results
    Patient characteristics were: median age (range), 67 (38-85); gender (male/female), 64/13; cancer type (lung cancer/thymic tumor/other), 72/3/2; chemotherapy regimen (HEC/MEC), 28/49. Aprepitant was not administered in 57% and 88% of patient who received HEC and MEC, respectively. In patients treated with aprepitant (n=18), therapeutic use of aprepitant after CINV occurred (n=9) decreased average NRS for nausea and average frequency of vomiting per day from 7.44 to 5.44 (p=0.10), and 2.11 to 0.11 (p=0.03), respectively. Prophylactic use of aprepitant in the second course (n=18) increased the proportion of patients with no significant nausea from 6% (first course) to 50% (second course, p=0.007), and those with no vomiting from 33% to 89% (p=0.002). In contrast, in patients who did not require aprepitant (n=59), proportion of patients with no significant nausea and those with no vomiting did not change during the 2 courses (76% to 76% [p=1.00] and 92% to 92% [p=1.00], respectively). In patients who required aprepitant, aprepitant use significantly improved FLIE scores in the second course while these did not change in patients who did not require aprepitant.

    Conclusion
    More than half of patients receiving HEC and 88% of patients receiving MEC did not require aprepitant. Aprepitant showed significant therapeutic and preventive effects on CINV in patients who truly need it.