Duggin, K., Tickle, K., Norman, G., Yang, J., Wang, C., Cross, S.J., . . . Mandrell, B. (2014). Aprepitant reduces chemotherapy-induced vomiting in children and young adults with brain tumors. Journal of Pediatric Oncology Nursing, 31, 277–283. 

DOI Link

Study Purpose

To determine if a 5HT3 receptor antagonist and aprepitant, an NK1 antagonist, without a corticosteroid were effective in reducing vomiting in pediatric patients with brain tumors receiving highly emetogenic chemotherapy (HEC)

Intervention Characteristics/Basic Study Process

This retrospective chart review investigated all patients (young adults and children) receiving the medulloblastoma protocol who were prescribed a 5HT3 antagonist plus aprepitant without a corticosteroid during their first course of HEC from September 9, 2003 to March 12, 2010. All cases were matched with two controls who received 5HT3 plus a corticosteroid.

Sample Characteristics

  • N = 52  
  • MEDIAN AGE = 13 years (range = 10–21 years)
  • MALES: 32, FEMALES: 20
  • KEY DISEASE CHARACTERISTICS: Patients with medulloblastoma; high- and average-risk patients included

Setting

  • SITE: Not stated
  • SETTING TYPE: Outpatient    
  • LOCATION: Unclear

Phase of Care and Clinical Applications

  • PHASE OF CARE: Active antitumor treatment
  • APPLICATIONS: Pediatrics and palliative care 

Study Design

Single-institution retrospective chart review

Measurement Instruments/Methods

  • Demographics, chemotherapy regimen, and medications were pulled from charts.

Results

Eighteen participants (aged 11–20 years with 14 patients aged greater than 18 years) received aprepitant. Thirty-four controls did not receive aprepitant (aged 10–20 years with 28 aged less than 18 years). 
 
The control group experienced grade 2 or higher chemotherapy-induced vomiting when compared to aprepitant recipients (p = 0.01; odds ratio = 3.52, 95% confidence interval = 1.47–8.42). The final multivariate generalized estimating equation model included group (aprepitant versus no aprepitant) and weeks of vomiting during radiation as explanatory variables. Patients who did not receive aprepitant were significantly more likely to have grade 2 or higher vomiting during the first course of HEC compared to aprepitant recipients (p = 0.03; odds ratio = 4.15, with 95% confidence interval = 1.59–10.82) after controlling for radiation-associated vomiting toxicity. On the day after HEC completion, 44% of the controls had delayed vomiting of grades 2 or 3 compared to 16% of aprepitant recipients.

Conclusions

The control group experienced grade 2 or higher chemotherapy-induced vomiting when compared to aprepitant recipients. When controlling for variables such as risk, age, and gender, patients who did not receive aprepitant were significantly more likely to have grade 2 or higher vomiting during the first course of HEC than aprepitant recipients.

Limitations

  • Small sample (< 100)

 

Nursing Implications

There is limited literature documenting chemotherapy-induced nausea and vomiting among pediatric patients, and this study provides helpful information to investigate the role of aprepitant. Prospective studies including patient-reported outcomes would be helpful in characterizing the benefits of aprepitant. The ability to better control chemotherapy-induced nausea and vomiting without the use of steroids is very beneficial.