title: Aprepitant reduces chemotherapy-induced vomiting in children and young adults with brain tumors.
abstract: OBJECTIVE
  Chemotherapy-induced nausea and vomiting are common and distressing side effects in patients with brain tumors and may be associated with radiation and the administration of highly emetogenic chemotherapy (HEC). Pediatric antiemetic guidelines recommend administration of a 5-hydroxytryptamine-3 (5HT3) receptor antagonists and the addition of aprepitant, a neurokinin 1 (NK1) antagonist with corticosteroids for the treatment of HEC. However, challenges persist in treating chemotherapy-induced nausea and vomiting in patients with brain tumors as corticosteroids are contraindicated due to potential impairment of the blood-brain barrier permeability. The objective was to determine whether a 5HT3 receptor antagonist and the addition of aprepitant, an NK1 antagonist without a corticosteroid, were effective in reducing HEC vomiting in pediatric brain tumor patients.
  
  
  METHODS
  A retrospective review found that 18 patients with a history of high-grade vomiting during radiation were prescribed a 5HT3 receptor antagonist and aprepitant without a corticosteroid during their first course of HEC. To determine the efficacy of aprepitant without a corticosteroid, each recipient was matched with 2 controls who did not receiv aprepitant.
  
  
  RESULTS
  During HEC, controls without aprepitant were more likely to have Grade 2 or higher vomiting than the aprepitant recipients (P = .03; odds ratio = 4.15; 95% confidence interval = 1.59-10.82), after controlling for radiation-associated vomiting toxicity.
  
  
  CONCLUSIONS
  Significantly less vomiting was identified in children receiving HEC and prescribed a 5HT3 receptor antagonist and aprepitant. Findings suggest that the addition of an NK1 antagonist may be beneficial to emetic control in this highly vulnerable population.
authors: St. Jude Children's Research Hospital, Memphis, TN, USA.
authors: Kelly
authors: K
authors: Duggin
authors: St. Jude Children's Research Hospital, Memphis, TN, USA.
authors: Kelly
authors: K
authors: Tickle
authors: St. Jude Children's Research Hospital, Memphis, TN, USA.
authors: Gina
authors: G
authors: Norman
authors: Stony Brook University, New York, NY, USA.
authors: Jie
authors: J
authors: Yang
authors: St. Jude Children's Research Hospital, Memphis, TN, USA.
authors: Chong
authors: C
authors: Wang
authors: St. Jude Children's Research Hospital, Memphis, TN, USA.
authors: Shane J
authors: SJ
authors: Cross
authors: St. Jude Children's Research Hospital, Memphis, TN, USA.
authors: Amar
authors: A
authors: Gajjar
authors: St. Jude Children's Research Hospital, Memphis, TN, USA belinda.mandrell@stjude.org.
authors: Belinda
authors: B
authors: Mandrell
mesh_terms: D000293:Adolescent; D000328:Adult; D000932:Antiemetics / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000009:adverse effects*; D001932:Brain Neoplasms / Q000188:drug therapy*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D009025:Morpholines / Q000627:therapeutic use*; D009325:Nausea / Q000139:chemically induced* / Q000188:drug therapy*; D012189:Retrospective Studies; D014839:Vomiting / Q000139:chemically induced* / Q000188:drug therapy*; D055815:Young Adult
chemical_list: D000932:Antiemetics; D000970:Antineoplastic Agents; D009025:Morpholines
keywords: aprepitant; chemotherapy-induced vomiting; children; young adults