Kusagaya, H., Inui, N., Karayama, M., Fujisawa, T., Enomoto, N., Kuroishi, S., . . . Suda, T. (2015). Evaluation of palonosetron and dexamethasone with or without aprepitant to prevent carboplatin-induced nausea and vomiting in patients with advanced non-small-cell lung cancer. Lung Cancer, 90, 410–416. 

DOI Link

Study Purpose

To compare the efficacy of triplet versus doublet antiemetic prophylaxis in patients receiving carboplatin-based chemotherapy

Intervention Characteristics/Basic Study Process

Patients were randomized to triple drug or doublet prophylaxis. Both groups received palonosetron 0.75 mg on day 1 and dexamethasone 8 mg on days 1–3. In addition, those randomized to triple drug therapy received aprepitant 125 mg on day 1 and 80 mg on days 2–3.  Physicians recorded the use of rescue therapy.

Sample Characteristics

  • N = 80
  • KEY SAMPLE CHARACTERISTICS: Patients were chemotherapy naive.

Setting

  • SITE: Multi-site   
  • SETTING TYPE: Not specified    
  • LOCATION: Japan

Phase of Care and Clinical Applications

PHASE OF CARE: Active antitumor treatment

Study Design

Open-label, randomized, two-group trial

Measurement Instruments/Methods

Complete response rate was defined as no vomiting or rescue therapy.

Results

Aprepitant and control groups showed overall complete response rates of 80.5% and 76.9%, respectively. No significant difference existed between groups. No differences existed in patient reports of nausea.

Conclusions

Doublet antiemetic prophylaxis using palonosetron was as effective as triplet antiemetic treatment for the control of chemotherapy-induced nausea and vomiting (CINV).

Limitations

  • Measurement/methods not well described
  • Method of measurement of nausea was not described.  
  • Nausea apparently was not considered in the definition of complete control.

Nursing Implications

The finding suggest that antiemetics with a 5-HT3 and dexamethasone were as effective as triplet therapy, including an NK1, for control of CINV in patients receiving carboplatin. The 5-HT3 used here was palonosetron. A variety of mixed evidence exists regarding the comparative efficacy of doublet versus triplet antiemetics for CINV, as well as the comparative efficacy of dexamethasone-paring regimens and olanzapine-based regimens. Ongoing research and evaluation of comparative effectiveness for various chemotherapy regimens are needed. Multiple factors need to be considered in individualization of antiemetic treatments, and nurses need to evaluate the effectiveness of interventions across cycles to provide the most effective regimen for each patient.