title: Chemotherapy-induced nausea and vomiting in the treatment of gastrointestinal tumors and secondary prophylaxis with aprepitant.
abstract: 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.
authors.affiliation: 3. Medizinische Klinik (Hamatologie/Onkologie), Munich, Germany.
authors.forename: Kathrin
authors.initials: K
authors.lastname: Abbrederis
authors.forename: Sylvie
authors.initials: S
authors.lastname: Lorenzen
authors.forename: Nadine
authors.initials: N
authors.lastname: Rothling
authors.forename: Angela
authors.initials: A
authors.lastname: Ihbe-Heffinger
authors.forename: Tibor
authors.initials: T
authors.lastname: Schuster
authors.forename: Christian
authors.initials: C
authors.lastname: Peschel
authors.forename: Florian
authors.initials: F
authors.lastname: Lordick
mesh_terms: 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*
chemical_list: D000932:Antiemetics; D000970:Antineoplastic Agents