Shi, Q., Li, W., Li, H., Le, Q., Liu, S., Zong, S., . . . Hou, F. (2016). Prevention of cisplatin-based chemotherapy-induced delayed nausea and vomiting using triple antiemetic regimens: A mixed treatment comparison. Oncotarget, 26, 24402-14. 

STUDY PURPOSE: To identify the best triple drug antiemetic regimen for cisplatin-induced nausea and vomiting

TYPE OF STUDY: Meta-analysis and systematic review

DATABASES USED: Not stated

INCLUSION CRITERIA: All were double-blind randomized controlled trials.

EXCLUSION CRITERIA: Not cisplatin-based therapy, no triple-drug regimen used, non-English language

• FINAL NUMBER STUDIES INCLUDED = 10
• TOTAL PATIENTS INCLUDED IN REVIEW = 7,317
• SAMPLE RANGE ACROSS STUDIES: 174–2,322 patients
• KEY SAMPLE CHARACTERISTICS: All were receiving cisplatin-based chemotherapy.

PHASE OF CARE: Active antitumor treatment

Pairwise meta-analysis was done to rank treatments for effectiveness in terms of complete response (CR) rate. Ranking for best results was: (a) netupitant, palonosetron, and dexamethasone (NEPA); (b) fosaprepitant, ondansetron, and dexamethasone; (c) palonosetron and dexamethasone; (d) fosaprepitant, granisetron, and dexamethasone. However, comparisons did not reach statistical significance. NEPA also ranked highest in percentage of cases with no nausea. The regimen of aprepitant, granisetron, and dexamethasone ranked highest in the side effect of constipation. The regimen of rolapitant, ondansetron, and dexamethasone ranked highest for delayed nausea control and fewest side effects. No significant differences existed across regimens in side effects.

Findings suggest that triple drug regimens, including NEPA, may be most effective in chemotherapy-induced nausea and vomiting (CINV) prevention and the prevention of delayed nausea, though actual differences across all triple drug regimens were not statistically significant.

The authors noted that some evidence reveals that the efficacy of various triple drug regimens may depend upon the tumor type rather than the antiemetic regimen. In general, all triple drug antiemetic regimens are shown to be effective for CINV management, and variation across regimens exists regarding their efficacy for nausea and response in the delayed phase, in particular. Further research is needed to identify comparative effectiveness for various regimens with analysis by tumor type as well as type of chemotherapy. In practice, given potential differences in effect, regimens for individual patients should be planned according to individual patient responses and risks.