Gao, H., Liang, Y., Zhou, N., Zhang, D., & Wu, H. (2011). Aprepitant plus palonosetron and dexamethasone for prevention of chemotherapy-induced nausea and vomiting in patients receiving multiple-day cisplatin-based chemotherapy. Internal Medicine Journal, 43, 73-76.

To evaluate the efficacy and safety of aprepitant in combination with palonsetron and dexamethasone in patients receiving three-day cisplatin-based chemotherapy

• Patients received three-day cisplatin-based chemotherapy and had never been treated with aprepitant. 
• All patients received the same antiemetic regimen of aprepitant 125 mg orally before chemotherapy on day 1 and 80 mg orally once daily on the following two days. 
• Palonosetron was given on days 1 and 3, and dexamethasone was given on days 1, 2, and 3. 
• The study physician evaluated efficacy and safety daily for seven days.  
• Patients were evaluated over multiple cycles of chemotherapy if applicable.

• The study consisted of 41 patients receiving a total of 89 cycles of chemotherapy.
• The median age of participants was 52.8 years (range = 21-74 years).
• Twenty-four patients (59%) were male, and 17 (41%) were female.
• Diagnoses were lung (32), nasopharyngeal (3), testicular (2), esophagus (2), stomach (1), and oropharyngeal (1).
• Eight of the patients were chemotherapy-naïve; 27 patients had a history of smoking, 16 had a history of drinking, 11 had a history of motion sickness, and 12 had a history of morning sickness.

This was a single-site study conducted in Guangzhou, China.

All patients were in active treatment.

This was a prospective, nonrandomized study.

Common Terminology Criteria for Adverse Events (CTCAE) of the National Cancer Institute, version 3.0, was used to assess nausea and safety.

• Findings indicated that 17% of patients had no nausea, 54% had grade 1 nausea, and 29% had grade 2 nausea. 
• With regard to vomiting, 63% had no vomiting in the acute phase, 78% had no vomiting in the delayed phase, and 58.5% had no vomiting overall. The number of patients reporting no vomiting decreased from 85% on day 1 of chemotherapy to 65% on day 3. 
• The most common side effects were hiccups (37%), fatigue (17%), headache (15%), and constipation (12%).  No adverse events were grade 2 or more. No cumulative toxicities from multiple chemotherapy cycles were reported.

Triple antiemetic medications of aprepitant, palonosetron, and dexamethasone are safe and effective for multiple-day chemotherapy to prevent vomiting.  The antiemetic efficacy is maintained during multiple chemotherapy cycles. The regimen was not as effective in preventing nausea.

• This study had a small sample of fewer than 100 participants.
• No control group was included. 
• The study was conducted at a single institution. 
• This was a nonrandomized study. 
• Descriptions of how the variables were measured were poor. For example, no information was provided on how vomiting was monitored and recorded.

Using the combination of aprepitant, palonosetron, and dexamethasone is effective in decreasing the incidence of chemotherapy-induced nausea and vomiting (CINV) in multiple-day chemotherapy regimens with low incidence of toxicity. Control of the symptom of nausea remains problematic.