Jordan, K., Blattermann, L., Hinke, A., Muller-Tidow, C., & Jahn, F. (2018). Is the addition of a neurokinin-1 receptor antagonist beneficial in moderately emetogenic chemotherapy?--A systematic review and meta-analysis. Supportive Care in Cancer, 26, 21–32.

STUDY PURPOSE: Define whether the addition of NK1Ras provides a clinically meaningful benefit for the prevention of nausea and vomiting in patients receiving moderately emetogenic chemotherapy

TYPE OF STUDY: Meta analysis and systematic review

DATABASES USED: MEDLINE (via Pubmed and Ovid) Central databases 

YEARS INCLUDED: January 1990 to October 2016.

INCLUSION CRITERIA: English language, randomized trials evaluating efficacy of NK1 for prevention of CINV in MEC

EXCLUSION CRITERIA: MEC multiple days, combine MEC and HEC, AC based, reviews with pooled analysis, design, retrospective, no randomization.

TOTAL REFERENCES RETRIEVED: 626 

EVALUATION METHOD AND COMMENTS ON LITERATURE USED: Initial evaluation done by one member of team, but two others then reviewed the results, and agreement was reached using consensus.

FINAL NUMBER STUDIES INCLUDED: 16 per literature, 15 evaluated in table.

TOTAL PATIENTS INCLUDED IN REVIEW: 3,848

SAMPLE RANGE ACROSS STUDIES: 23-707

KEY SAMPLE CHARACTERISTICS: Studies evaluating the efficacy of NK-1 in chemotherapy with moderately emetogenic chemotherapy, multiple types of cancer, lung, gynecologic, colorectal, and head and neck cancers

PHASE OF CARE: Active anti-tumor treatment     

APPLICATIONS: Elder care, palliative care

Overall, a total of 626 published articles or abstracts were pulled for this systemic review. Based on the inclusion and exclusion criteria, the final review included 13 trials and three abstracts. Only two trials evaluated use of NK-1 in pure MEC regimens. The authors categorized trials as pure MEC (excluding regimens with carboplatin or oxaliplatin), regimens containing carboplatin, and regimens containing oxaliplatin. In the pure MEC group, the addition of an NK-1-RA significantly improved CINV complete response (p = 0.02). In the carboplatin group, the addition of an NK-1-RA significantly improved CINV complete response (p < 0.001). In the oxaliplatin group, the addition of an NK-1-RA did not significantly improved CINV complete response (p = 0.17).

The authors discuss that the addition of NK-1 does improve CINV in carboplatin regimens with moderate emetogenicity, but the benefit is not clear for other moderately emetogenic chemotherapy regimens. This use of NK-1 in moderately emetogenic chemotherapy is not reported in guidelines, but there is still a need to answer the question of benefit in this patient population. With carboplatin, there was evidence of usefulness in patients receiving carboplatin with doses at AUC 4 and above. In mixed regimens, it is difficult as emetogenicity ranges from 30%-90%. Only two trials were evaluated in oxaliplatin containing regimens.

• High heterogeneity

Consideration of adding NK-1 in carboplatin containing regimens is supported by results. Ongoing research is needed to further define patients who would benefit from NK-1 medications.