Miya, T., Kobayashi, K., Hino, M., Ando, M., Takeuchi, S., Seike, M., . . . East Japan Chesters Group. (2016). Efficacy of triple antiemetic therapy (palonosetron, dexamethasone, aprepitant) for chemotherapy-induced nausea and vomiting in patients receiving carboplatin-based, moderately emetogenic chemotherapy. Springerplus, 5, 2080-016-3769-x. 

To assess the efficacy of triple drug antiemetic prophylaxis for patients receiving moderately emetogenic chemotherapy (MEC)

Patients receiving MEC containing carboplatin were treated with standard triple drug antiemetic therapy of palonosetron, dexamethasone, and aprepitant. Patients were assessed from the beginning of chemotherapy to day 7.

• N = 90   
• MEDIAN AGE = 69 years
• AGE RANGE = 38-82 years
• MALES: 80%, FEMALES: 20%
• KEY DISEASE CHARACTERISTICS: Not provided
• OTHER KEY SAMPLE CHARACTERISTICS: All patients were chemotherapy naïve except for patients with lung cancer receiving tyrosine kinase inhibitors.

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

PHASE OF CARE: Active antitumor treatment

Prospective, observational

• Functional Living Index-Emesis (FLI-E) questionnaire
• 100 mm visual analog scale (VAS) for quality of life and nausea severity
• Common Terminology Criteria for Adverse Events (CTCAE)

No patient vomited within the first 24 hours after chemotherapy. For the delayed and overall phases, completed response was seen in 91.9% of patients. Complete control was seen in 88.9%–97.8% across study days. The lowest rate of complete control was seen on day 3. Men tended to have a high prevalence of complete response and complete control. Hypertension of grade 3, which may have been related to the study drugs, was seen in five patients. Comparison to findings from five other studies showed high complete response rates in the present study.

Triple drug therapy for the prevention of chemotherapy-induced nausea and vomiting (CINV) was shown to be very effective for patients receiving MEC.

• Small sample (< 100)
• Risk of bias (no control group)
• Risk of bias (no blinding)
• Risk of bias (no random assignment)
• Unintended interventions or applicable interventions not described that would influence results
• No discussion of any use of rescue medication
• No direct comparison to more standard MEC regimens for antiemesis

Triple antiemetic therapy is recommended in several professional guidelines for highly emetogenic chemotherapy but not for MEC. This study showed better efficacy for CINV control compared to some other studies in CINV management for MEC. Triple drug antiemetic prophylaxis should be considered for patients receiving MEC.