Kaushal, P., Atri, R., Soni, A., & Kaushal, V. (2015). Comparative evaluation of triplet antiemetic schedule versus doublet antiemetic schedule in chemotherapy-induced emesis in head and neck cancer patients. ecancermedicalscience, 9, 567. 

DOI Link

Study Purpose

To compare the efficacy of triplet versus doublet antiemetic therapy in patients receiving mitoxantrone, etoposide, and cytarabine (MEC) chemotherapy

Intervention Characteristics/Basic Study Process

Patients were randomized to receive either palonosetron, dexamethasone, and aprepitant, or ondansetron and dexamethasone for chemotherapy-induced nausea and vomiting (CINV) control.

Sample Characteristics

  • N = 60
  • MEAN AGE = 51 years
  • AGE RANGE = 34–70 years
  • MALES: 86.6%, FEMALES: 13.4%
  • KEY DISEASE CHARACTERISTICS: All patients had head and neck cancer.

Setting

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

Phase of Care and Clinical Applications

  • PHASE OF CARE: Active antitumor treatment

Study Design

  • Open-label, randomized, prospective trial

Measurement Instruments/Methods

  • Count of emesis episodes
  • Nausea measured on 100 mm visual analog scale (VAS)

Results

Complete response (CR), defined as no vomiting and no rescue medications, was seen in 86.7% of those on triplet therapy and 60% of those on doublet therapy in the acute phase (p < 0.05). In the delayed phase, the CR was 83.3% and 53.3% of those on triplet and doublet therapy respectively (p < 0.05). The authors cited the WHO cost effective and strategic planning guidelines to note that because triplet therapy was more effective, it was cost-effective.

Conclusions

The findings showed that triplet therapy was associated with higher CR rates for CINV prevention than doublet therapy (without an NK1) for patients receiving MEC.

Limitations

  • Small sample (< 100)
  • Risk of bias (no blinding)

 

Nursing Implications

A growing volume of research exists to compare antiemetic regimens with and without NK1s, likely because of the cost of NK1 medication. This study showed that triplet therapy containing NK1 was effective for the control of CINV in a greater proportion of patients than doublet therapy. CINV is a debilitation side effect of chemotherapy. Nurses can advocate for the use of the interventions that are most effective for symptom control among patients receiving MEC and HEC.