Uchino, J., Hirano, R., Tashiro, N., Yoshida, Y., Ushijima, S., Matsumoto, T., … Watanabe, K. (2012). Efficacy of aprepitant in patients with advanced or recurrent lung cancer receiving moderately emetogenic chemotherapy. Asian Pacific Journal of Cancer Prevention: APJCP, 13, 4187-4190.

To evaluate the efficacy of aprepitant combined with conventional antiemetic therapy in patients receiving moderately emetogenic chemotherapy

5-HT₃ receptor antagonists were given 30 minutes prior to chemotherapy. Aprepitant was given orally at 125 mg on day 1 and 80 mg on days 2 and 3. Dexamethasone was given by infusion 30 minutes prior to chemotherapy. Patients were followed for five days. Results in these patients were compared to a control group that received only 5-HT₃ and dexamethasone.

• The study consisted of 52 patients.
• The mean age was 68.2, with a range of 34-83.
• The majority of the sample (73%) was male, and 27% was female.
• All patients had lung cancer.
   

The study was conducted at a single inpatient site in Japan.

All patients were in active antitumor treatment.

This was a retrospective study.

• The Common Terminology Criteria for Adverse Events was used.
• Complete response (CR) was defined as complete suppression of vomiting and no rescue medication.
• Food intake was measured.
• Chemotherapy completion rate was monitored.

• The CR for control of vomiting was 96% in controls and 100% in the group that was given aprepitant. 
• Complete suppression of nausea was reported as 89% among controls and 96% in the aprepitant group (p = 0.0043). 
• The amount of food intake was greater in the aprepitant group. 
• Completion of planned chemotherapy was higher in the aprepitant group (73.3% versus 88.2%, p = 0.042).

The addition of aprepitant to standard antiemtic therapy in patients receiving moderately emetogenic chemotherapy was associated with less nausea and vomiting and better food intake.

• The study had a small sample of fewer than 100 patients.
• A risk of bias exists because no control group, blinding, or random assignment was included.
• Rescue medications used were not described.  
• Whether differences in completion of the planned chemotherapy were related to chemotherapy-induced nausea and vomiting (CINV) or other toxicities was not clear.

Neurokinin 1 (NK1) receptor antagonists have been recommended for highly emetogenic chemotherapy (HEC); however, less evidence is available regarding their use with moderately emetogenic regimens (MEC).  This study suggests that the addition of NK1 to MEC is beneficial for reduction of CINV in this group of patients. Nurses can advocate for maximal symptom control to prevent CINV, one of the most severe adverse effects of chemotherapy.