Kitazaki, T., Fukuda, Y., Fukahori, S., Oyanagi, K., Soda, H., Nakamura, Y., & Kohno, S. (2015). Usefulness of antiemetic therapy with aprepitant, palonosetron, and dexamethasone for lung cancer patients on cisplatin-based or carboplatin-based chemotherapy. Supportive Care in Cancer, 23, 185–190.

DOI Link

Study Purpose

To evaluate the effectiveness of a combination of aprepitant, palonosetron, and dexamethasone during the acute and delayed phase of chemotherapy-induced nausea and vomiting (CINV) in patients with lung cancer receiving carboplatin-based, moderately emetogenic chemotherapy or cisplatin-based, highly emetogenic chemotherapy

Intervention Characteristics/Basic Study Process

133 patients with lung cancer receiving carboplatin-based or cisplatin-based chemotherapy from September 2010 until December 2011
 
Patients receiving carboplatin-based chemotherapy received the following prophylactic antiemetics.
  • Day 1: Aprepitant 125 mg PO, palonosetron 0.75 mg IV, and dexamethasone 3.3 mg IV
  • Days 2 and 3: Aprepitant 80 mg PO
 
Patients receiving cisplatin-based chemotherapy received the following prophylactic antiemetics.
  • Day 1: Aprepitant 125 mg PO, palonosetron 0.75 mg IV, and dexamethasone 9.9 mg IV
  • Days 2 and 3: Aprepitant 80 mg PO and dexamethasone 3.3 mg IV
 
The patients completed questionnaires on self-reported nausea and vomiting on days 1–5. The percentage of patients with a complete response (no nausea and no use of rescues medications) was the primary endpoint.

Sample Characteristics

  • N = 133 courses
  • MEAN AGE = 65.8 years
  • MALES: 77%, FEMALES: 23%
  • KEY DISEASE CHARACTERISTICS: Lung cancer
  • OTHER KEY SAMPLE CHARACTERISTICS: Prior experiences of CINV and motion sickness and a history of alcohol consumption

Setting

  • SITE: Single site    
  • SETTING TYPE: Not specified    
  • LOCATION: Department of Respiratory Medicine at Sasebo City General Hospital in Japan

Phase of Care and Clinical Applications

  • PHASE OF CARE: Active antitumor treatment
  • APPLICATIONS: Palliative care 

Study Design

This study was a prospective trial.

Measurement Instruments/Methods

  • Patients completed a self-reported questionnaire on the presence of emesis (yes or no), level of nausea (four choices), and status of salvage treatment. This questionnaire was completed on days 1–5.

Results

Complete response (CR) was defined as the absence of nausea with no salvage treatment required. From days 1–5, 86% of patients receiving carboplatin-based chemotherapy achieved CR (95%, CI: 78–93), and 71% of patients receiving cisplatin-based chemotherapy achieved CR (95%, CI: 58–84). In the acute phase, patients receiving carboplatin-based chemotherapy and patients receiving cisplatin-based chemotherapy had similar CR rates (98% versus 100%). In the delayed phase (days 2–5), 87% of patients receiving carboplatin-based chemotherapy achieved CR (95%, CI: 94–100), and 71% of patients receiving cisplatin-based chemotherapy achieved CR (95%, CI: 58–84).
 
For patients receiving carboplatin-based chemotherapy or cisplatin-based chemotherapy, there were no significant differences in gender, age, prior experience of emesis after chemotherapy, history of alcohol intake, or prior experience of motion sickness. 

Conclusions

Patients who received carboplatin or cisplatin-based chemotherapy had CINV, even with prophylaxis including aprepitant, palonosetron, and dexamethasone. There was no difference in CINV rates between patients who received carboplatin and those who received cisplatin-based chemotherapy. This study did not compare this regimen to any other prophylaxis, so it is difficult to draw a conclusion regarding the usefulness of this regimen for CINV prophylaxis for moderately or highly emetogenic chemotherapy.

Limitations

  • Risk of bias (no control group)
  • Findings not generalizable
  • Other limitations/explanation: This study only included patients with lung cancer who received carboplatin- or cisplatin-based chemotherapy. The prospective study included only one facility. The findings of this study may not be generalizable.

Nursing Implications

This article provides information on CINV for patients with lung cancer receiving carboplatin- or cisplatin-based chemotherapy who have taken prophylactic aprepitant, palonosetron, and dexamethasone. This information may help inform nurses providing patient education about acute and delayed CINV in this population. 
 
The use of a combination of aprepitant, palonosetron, and dexamethasone as prophylactic treatment for CINV was effective for the majority of patients with lung cancer receiving carboplatin- and cisplatin-based protocols in this study in the acute, delayed, and overall phases after chemotherapy administration.