Ito, S., Tsukiyama, I., Ando, M., Katakami, M., Hamanaka, R., Kosaka, K., . . . Kubo, A. (2015). Therapeutic and preventive antiemetic effect of aprepitant in Japanese patients with thoracic malignancies who truly need it. Supportive Care in Cancer, 23, 905–912. 

To evaluate whether all patients undergoing highly emetogenic chemotherapy (HEC) need an NK₁ and to evaluate the effects of aprepitant on patients who experience chemotherapy-induced nausea and vomiting (CINV) in the first course of therapy

Patients received standard antiemetics consisting of IV granisetron on day 1 and dexamethasone on days 1–3 when given highly emetogenic chemotherapy (HEC) or moderately emetogenic chemotherapy (MEC). Patients who needed aprepitant experienced CINV and received aprepitant prophylactically for the subsequent courses of chemotherapy. Other agents for rescue antiemesis were allowed. Pharmacists visited patients on days 1–6 to assist them with completing diaries to record symptoms.

• N = 77
• MEAN AGE = 67 years
• AGE RANGE = 38–85 years
• MALES: 83.1%, FEMALES: 16.9%
• KEY DISEASE CHARACTERISTICS: Of the patients, 93.5% had lung cancer.
• OTHER KEY SAMPLE CHARACTERISTICS: Of the patients, 36.4% were receiving HEC and the rest were receiving MEC.

• SITE: Single site  
• SETTING TYPE: Not specified  
• LOCATION: Japan

• PHASE OF CARE: Active antitumor treatment

• Retrospective, descriptive

• Eleven-point numeric rating scale for nausea
• Functional Living Index-Emesis (FLIE)

Eighteen patients (23%) needed aprepitant after the first course of chemotherapy. Those receiving HEC who needed aprepitant experienced a significant improvement in the prevention of CINV (p = 0.018) and had less need for rescue medications (p = 0.001). Those receiving MEC also experienced an improvement in CINV after the use of aprepitant, although the difference was not statistically significant. Most improvement was seen in the delayed phase. Though vomiting was reduced, no significant improvement in nausea was observed. About 50% of patients required rescue antiemetics with the first course of chemotherapy.

Not all patients receiving HEC or MEC need an NK₁ to prevent CINV. Aprepitant was effective in preventing vomiting in patients who had CINV during the first course of chemotherapy.

• Small sample (< 100)
• Risk of bias (no blinding)
• Risk of bias (no random assignment)
• Unintended interventions or applicable interventions not described that would influence results
• No information regarding rescue medications used is provided.

The findings suggest that all patients may not need NK₁s for complete control of CINV; however, no evidence predicts which patients will or will not experience CINV without an NK₁. Current guidelines recommend triplet antiemetics for HEC. Further work to identify the factors that would predict the patients who need NK₁s would be helpful to potentially provide control of CINV without the high cost of NK₁s.