Grunberg, S.M., Dugan, M., Muss, H., Wood, M., Burdette-Radoux, S., Weisberg, T., & Siebel, M. (2009). Effectiveness of a single-day three-drug regimen of dexamethasone, palonosetron, and aprepitant for the prevention of acute and delayed nausea and vomiting caused by moderately emetogenic chemotherapy. Supportive Care in Cancer, 17, 589–594. 

To evaluate the safety and efficacy of aprepitant, dexamethasone, and palonosetron as an antiemetic regimen for prevention of acute and delayed nausea and vomiting

Patients received one oral dose of 285 mg aprepitant and 20 mg dexamethasone one hour prior to cyclophosphamide and/or doxorubicin chemotherapy and 25 mg IV palonosetron 30 minutes prior to chemotherapy. Patients completed study diaries prior to the start of the single-day chemotherapy and then daily for five days.

• The sample consisted of 41 participants.
• Median age was 51, with a range of 33–74 years.
• Forty of the patients were female (97.5%), and one was male (2.5%). 
• Patients were diagnosed with solid tumors (no other information provided). The majority (n = 41) had performance statuses of 0 or 1.
• All patients received cyclophosphamide; 90% received doxorubicin and cyclophosphamide combination therapy.
• Patients could not receive corticosteroids or antiemetic agents other than the study drug doses immediately before or during the study period.

The study was conducted at multiple outpatient settings in Vermont and Maine.

All patients were in active treatment.

The study was a prospective trial.

• Patients recorded frequency and intensity of nausea and vomiting in study diaries.
• Nausea and vomiting was also measured based on the use of rescue antiemetic medication.

• Overall
  • 51% had a complete response (no vomiting and no rescue therapy)
  • 95% had no emesis
  • 32% had no nausea
• Acute phase (0–24 hours post chemotherapy)
  • 76% had complete response
  • 100% had no emesis
  • 59% had no nausea
• Delayed phase (24–100 hours post chemotherapy)
  • 66% had complete response
  • 95% had no emesis
  • 41% had no nausea
• Only 27% of patients had more than 1 day of significant nausea.
• No major adverse effects from medications were noted.

The single-day, three-drug (aprepitant, dexamethasone, palonosetron) antiemetic regimen is a safe and effective antiemetic regimen for patients receiving mildly or minimally emetogenic chemotherapy.

• No control group or comparison was provided.
• Only patients with low potential for nausea and vomiting were included in the study.
• Potential for bias exists, as patients may have underestimated their symptoms or rescue medications because they were a part of a study.

Identifying effective single-day antiemetic regimens may improve adherence to supportive care guidelines and reduce nausea and vomiting symptoms in patients receiving chemotherapy.