Jordan, K., Warr, D.G., Hinke, A., Sun, L., & Hesketh, P.J. (2016). Defining the efficacy of neurokinin-1 receptor antagonists in controlling chemotherapy-induced nausea and vomiting in different emetogenic settings--A meta-analysis. Supportive Care in Cancer, 24, 1941–1954.

STUDY PURPOSE: The purpose of this meta-analysis is to compile the evidence on and report the efficacy of neurokinin-1 receptor antagonists (NK1RAs) for the prevention of CINV.

TYPE OF STUDY: Meta analysis and systematic review

DATABASES USED: MEDLINE (via PubMed) and OVID

YEARS INCLUDED: 1990-2014

INCLUSION CRITERIA: Randomized controlled trial, using the addition of an NK1RA in addition to standard antiemetic therapy, defined as a 5-HT₃-RA plus a glucocorticoid, in patients with cancer receiving chemotherapy, published in English.  

EXCLUSION CRITERIA: CINV prevention not examined, pharmacokinetic studies, risk factors for CINV, quality-of-life studies. Not independent data set, pooled analysis, dose finding studies.

TOTAL REFERENCES RETRIEVED: 1,987

EVALUATION METHOD AND COMMENTS ON LITERATURE USED: Two authors screened for eligibility of articles to be included. Of the articles deemed eligible for inclusion, one author would review to abstract out information and this was reviewed by a second author.

FINAL NUMBER STUDIES INCLUDED: 23

TOTAL PATIENTS INCLUDED IN REVIEW: 11,814

SAMPLE RANGE ACROSS STUDIES: 36–1,449

KEY SAMPLE CHARACTERISTICS: People with cancer, receiving chemotherapy for cancer

PHASE OF CARE: Active anti-tumor treatment

Compiling the results from all eligible studies reviewed, the authors found that adding a NK1RA to a standard antiemetic regimen provided better emesis control than a standard antiemetic regimen alone in patients receiving cisplatin-based highly emetogenic chemotherapy and anthracycline/cyclophosphamide (AC)-based highly emetogenic chemotherapy (all p < 0.00001). In patients receiving moderately emetogenic chemotherapy, there were no statistically significant differences in emesis between NK1RA plus standard antiemetic regimen and standard antiemetic regimen alone. In patients receiving high-dose chemotherapy before stem cell transplantation and cisplatin-based multiple-day chemotherapy (MDC) regimens, adding a NK1RA to a standard antiemetic regimen provided better emesis control (all p < 0.05).

Adding an NK1RA to standard antiemetic regimens can reduce CINV in patients receiving highly emetogenic chemotherapy. Adding an NK1RA to standard antiemetic regimens with moderately emetogenic therapy did not demonstrate an added benefit to preventing CINV.

Adding an NK1RA to standard antiemetic regimens in people receiving a chemotherapy regimen classified as highly emetogenic can reduce CINV.