Chemotherapy-induced nausea and vomiting in the treatment of gastrointestinal tumors and secondary prophylaxis with aprepitant.
BACKGROUND
Chemotherapy-induced nausea and vomiting (CINV) belongs to the most feared side-effects of cancer treatment. Its incidence during chemotherapy of gastrointestinal tumors (GITs) with highly and moderately emetogenic regimens is not well documented. It is also unknown whether aprepitant, a neurokinin-1 receptor antagonist, can be used as secondary antiemetic prophylaxis in case of CINV during cycle 1.


METHODS
Patients with GITs who were treated with highly and moderately emetogenic chemotherapy received standard antiemetic prophylaxis including a 5-hydroxytryptamine-3 receptor antagonist and dexamethasone. In case of CINV > grade 1 (National Cancer Institute classification) during the first chemotherapy course, aprepitant was additionally administered with further cycles.


RESULTS
We screened 109 patients. 16 patients (15%) experienced acute and/or delayed CINV. Features associated with CINV were low-dose cisplatin-containing chemotherapy (15/16 patients), female gender (11/16 patients), abstinence to alcohol (11/16 patients) and former emesis gravidarum (11/16 patients). 11 patients who got further courses of the same chemotherapy received aprepitant. 7 are fully assessable for response. 5 of 7 patients had a complete protection from CINV (71%) and 1 patient had improved symptoms.


CONCLUSIONS
In the majority of cases, primary standard antiemetic prophylaxis provided adequate protection against CINV. In case of failure to primary prophylaxis, secondary prophylaxis with aprepitant showed a high efficacy against CINV.
Abbrederis
Kathrin
K
3. Medizinische Klinik (Hamatologie/Onkologie), Munich, Germany.
Lorenzen
Sylvie
S
Rothling
Nadine
N
Ihbe-Heffinger
Angela
A
Schuster
Tibor
T
Peschel
Christian
C
Lordick
Florian
F
D000328:Adult; D000368:Aged; D000932:Antiemetics / Q000008:administration & dosage / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D005770:Gastrointestinal Neoplasms / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D008875:Middle Aged; D009325:Nausea / Q000139:chemically induced* / Q000517:prevention & control*; D010818:Practice Patterns, Physicians' / Q000639:trends; D016896:Treatment Outcome; D014839:Vomiting / Q000139:chemically induced* / Q000517:prevention & control*
D000932:Antiemetics; D000970:Antineoplastic Agents