Wu, C.E., & Liaw, C.C. (2012). Using aprepitant as secondary antiemetic prophylaxis for cancer patients with cisplatin-induced emesis. Supportive Care in Cancer, 20, 2357–2361.

To evaluate the efficacy aprepitant as an additional antiemetic among individuals who failed to obtain nausea and vomiting relief from 5-HT₃ antagonists and dexamethasone while receiving cisplatin-based chemotherapy

Physician and nurse investigators recorded patients' nausea and vomiting episodes daily while they were hospitalized. If discharged, patients their symptoms daily for up to 6 days.

• The study reported on 257 patients.
• Median age was 62 years with a range of 26–82.
• the sample was 70% male and 30% female.
• Cancer diagnoses were genitourinary (54.6%), gastrointestinal (20.2%), head and neck (13.2%), breast (3.9%), lung (3.5%), and other (6.6%).
• All patients had no prior exposure to cisplatin-based chemotherapy, and 97% of patients were chemotherapy naïve.

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

All patients were in active antitumor treatment.

This was a prospective, descriptive study.

• Vomiting was measured on a four-point scale of complete response, major response, minor response, or failure. 
• Nausea was measured on a four-point scale of none, mild, moderate, or severe.
• The acute phase was defined as day 1 of chemotherapy infusion, and the delayed phase was defined as days 2–6.

• In cycle 1, 19% of patients reported acute and delayed nausea and vomiting. 
• In cycle 2, 40 of 49 patients with CINV received aprepitant, and 98% experienced complete protection from acute vomiting, 93% from acute nausea, 65% from delayed vomiting, and 60% from delayed nausea.
• In cycle 3, 35 of 40 patients with CINV received aprepitant, and 100% experienced complete protection from acute vomiting, 100% from acute nausea, 77% from delayed vomiting, and 71% from delayed nausea.
• Adverse events associated with aprepitant for each cycle were hiccups (n = 5) and constipation (n = 4).

Aprepitant is an effective additional agent for CINV with minimal side effects; however, the medication should not routinely be used because only a small percentage of patients need an additional antiemetic.

• A risk of bias exists because no control group, blinding, or random assignment was used in this study. For example, while patients were hospitalized, the investigators collected their own data and, when patients were discharged, patients' providers were asking for the data.
• Key sample group differences could have influenced results.
• Measurement and methods were not well described, and measurement validity and reliability were questionable.
• Findings are not generalizable to other populations. The sample was primarily patients who were chemotherapy naïve, which may have influenced the overall rates of CINV.
• Although categories remained consistent for the measurement of nausea and vomiting, consistency in data collection (e.g., time of day), which may have influenced results, was not described. 
• Validity and reliability of the measurements was not described, and inter-rater evaluation was not performed to ensure consistency of measurement. 
• Delayed nausea and vomiting was defined as days 2–6 after chemotherapy, which is not typical timing for a delayed measurement.
• The generalizability of these findings is limited because it was a single institution study; furthermore, these findings are generalizable only to patients receiving cisplatin-based chemotherapy.
• Adverse events were reported in the results but the authors did not state how this information was obtained.

Nurses need to assess for CINV throughout chemotherapy and advocate for additional antiemetic therapy when needed. Aprepitant is an effective additional antiemetic medication for relief of CINV among patients receiving cisplatin-based chemotherapy.