title: Aprepitant as salvage therapy in patients with chemotherapy-induced nausea and emesis refractory to prophylaxis with 5-HT(3) antagonists and dexamethasone.
abstract: BACKGROUND
  Despite prophylaxis with 5-HT(3) antagonists and dexamethasone, nausea/emesis are common chemotherapy- induced toxicities. The aim of this trial was to evaluate the efficacy of adding the NK1 antagonist aprepitant in patients refractory to standard prophylaxis.
  
  
  METHODS
  Patients with significant nausea/vomiting despite prophylaxis with 5-HT(3) antagonists and dexamethasone were eligible. Aprepitant was added to the same antiemetic regimen used during previous cycles.
  
  
  RESULTS
  34 patients received 92 cycles of chemotherapy with aprepitant which was applied orally at 125 mg on day 1 and 80 mg on days 2 and 3. All patients were refractory to standard antiemetic prophylaxis during cisplatin-based (n = 12) or other chemotherapy (n = 22). With the addition of aprepitant, all patients reported subjective improvement. The number of patients with nausea for >4 days decreased from 24 (71%) to 4 (12%) (p < 0.001), and the number of those with emesis for >2 days decreased from 26 (77%) to 0 (0%) (p < 0.001). In 12 patients receiving aprepitant for >2 cycles (3-8) the efficacy was maintained. No toxicity possibly related to aprepitant was observed.
  
  
  CONCLUSIONS
  Aprepitant demonstrated significant activity in patients with nausea/vomiting refractory to prophylaxis with 5-HT(3) antagonists and dexamethasone.
authors.affiliation: Medizinische Klinik und Poliklinik II, Abteilung für Hämatologie / Onkologie / Immunologie / Rheumatologie / Pulmonologie, Universitätsklinik Tübingen, Germany.
authors.forename: Karin
authors.initials: K
authors.lastname: Oechsle
authors.forename: Martin R
authors.initials: MR
authors.lastname: Müller
authors.forename: Jörg T
authors.initials: JT
authors.lastname: Hartmann
authors.forename: Lothar
authors.initials: L
authors.lastname: Kanz
authors.forename: Carsten
authors.initials: C
authors.lastname: Bokemeyer
mesh_terms: D000287:Administration, Topical; D000328:Adult; D000368:Aged; D000932:Antiemetics / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000009:adverse effects*; D000077608:Aprepitant; D003907:Dexamethasone / Q000009:adverse effects* / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009025:Morpholines / Q000008:administration & dosage*; D009325:Nausea / Q000139:chemically induced / Q000517:prevention & control*; D009369:Neoplasms / Q000150:complications / Q000188:drug therapy; D016879:Salvage Therapy / Q000379:methods*; D058831:Serotonin 5-HT3 Receptor Antagonists; D012702:Serotonin Antagonists / Q000008:administration & dosage / Q000009:adverse effects*; D016896:Treatment Outcome; D014839:Vomiting / Q000139:chemically induced / Q000517:prevention & control*
chemical_list: D000932:Antiemetics; D009025:Morpholines; D058831:Serotonin 5-HT3 Receptor Antagonists; D012702:Serotonin Antagonists; D000077608:Aprepitant; D003907:Dexamethasone