Chapell, R., & Aapro, M.S. (2013). Efficacy of aprepitant among patients aged 65 and over receiving moderately to highly emetogenic chemotherapy: A meta-analysis of unpublished data from previously published studies. Journal of Geriatric Oncology, 4(1), 78–83. 

DOI Link

Purpose

STUDY PURPOSE: To review the evidence related to efficacy of aprepitant in patients over age 65
 
TYPE OF STUDY: Meta-analysis and systematic review

Search Strategy

DATABASES USED: Merck & Company's internal records
 
KEYWORDS: No search terms. Looked for randomized, double-blind, placebo-controlled, parallel-group studies.
 
INCLUSION CRITERIA: Studies included patients both under and over age 65, results were stratified by age, and standard therapy was compared to antiemetic regimen including aprepitant.  
 
EXCLUSION CRITERIA: None listed

Literature Evaluated

TOTAL REFERENCES RETRIEVED = Article does not say
 
EVALUATION METHOD AND COMMENTS ON LITERATURE USED: A comprehensive meta-analysis was used to combine results from all four studies for a fixed-effects model. Relative risk was calculated across studies in different age groups and were compared using the Q test of heterogeneity. 

Sample Characteristics

  • FINAL NUMBER STUDIES INCLUDED = 4 
  • TOTAL PATIENTS INCLUDED IN REVIEW = Not reported
  • SAMPLE RANGE ACROSS STUDIES: Not reported
  • KEY SAMPLE CHARACTERISTICS: Three studies included patients with solid tumors; one study included breast cancer only.

Phase of Care and Clinical Applications

PHASE OF CARE: Active antitumor treatment
 
APPLICATIONS: Elder care

Results

The relative risk of complete response for patients under 65 is 1.30 (95% CI: 1.19–1.42; p < 0.0001). It is not significantly different from patients over 65 (Q = 0.281, p = 0.596). The relative risk for a complete response for patients over 75 is 1.42 (95% CI: 1.07–1.89; p = 0.02). It is not significantly different from the relative risk for patients under the age of 75 (1.28, 95% CI: 1.19–1.37; Q = 0.49, p = 0.78). The relative risk of a complete response to regimens including aprepitant for patients over 75 is not different for patients under 65 (Q = 0.42, p = 0.81). There was no statistically significant difference in heterogeneity among studies.

Conclusions

Aprepitant is beneficial for patients both over and under age 65.

Limitations

  • Included studies did not use the same chemotherapy regimen.
  • Extremely limited demographic data were presented.
  • Search did not include major databases.
  • No year limits were described in the study.
  • Authors did not state how many studies were retrieved.

Nursing Implications

The addition of aprepitant should be considered in patients, regardless of age, for the management of chemotherapy-induced nausea and vomiting associated with moderate and highly emetogenic chemotherapy.

Legacy ID

4470