title: Palonosetron with aprepitant plus dexamethasone to prevent chemotherapy-induced nausea and vomiting during gemcitabine/cisplatin in urothelial cancer patients.
abstract: OBJECTIVE
  To evaluate the appearance of chemotherapy-induced nausea and vomiting, and to compare the antiemetic efficacy of the triple combination of palonosetron, aprepitant and dexamethasone with that of our old regimen using first-generation 5-hydroxytryptamine 3-receptor antagonists and dexamethasone during gemcitabine and cisplatin chemotherapy in patients with advanced urothelial cancer.
  
  
  METHODS
  We carried out a multi-institutional study including 122 patients who received gemcitabine and cisplatin for advanced urothelial cancer between February 2005 and January 2012. Uncontrolled chemotherapy-induced nausea and vomiting events were identified through records of nausea and vomiting, additional infusion, rescue medications, and/or records of food intake.
  
  
  RESULTS
  First-generation 5-hydroxytryptamine 3-receptor antagonists (ondansetron or granisetron) plus dexamethasone were used for 75 patients (cohort 1), and palonosetron with dexamethasone plus aprepitant for 47 patients (cohort 2). Patients in cohort 2 had significantly higher complete response (defined as no emetic episodes and no rescue medication use) rates than those in cohort 1 during the overall phase in the first cycle (85.7% vs 65.3%, P = 0.012), and all cycles (78.7% vs 50.7%, P = 0.0019) of gemcitabine and cisplatin. Patients in cohort 2 were more likely to achieve more favorable chemotherapy-induced nausea and vomiting control; that is, a lower grade of nausea, vomiting or anorexia, lower incidence of rescue therapy required, and shorter time to become chemotherapy-induced nausea- and vomiting-free than patients in cohort 1.
  
  
  CONCLUSIONS
  The present results show that palonosetron in combination with aprepitant and dexamethasone is more effective to prevent chemotherapy-induced nausea and vomiting in urothelial cancer patients treated with gemcitabine and cisplatin than first-generation 5-hydroxytryptamine 3-receptor antagonists plus dexamethasone.
authors.affiliation: Department of Urology, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kitamura
authors.affiliation: Department of Urology, Hakodate Goryoukaku Hospital, Hakodate, Hokkaido, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Takahashi
authors.affiliation: Department of Urology, Japanese Red Cross Asahikawa Hospital, Asahikawa, Hokkaido, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Hotta
authors.affiliation: Department of Urology, Muroran City General Hospital, Muroran, Hokkaido, Japan.
authors.forename: Ryuichi
authors.initials: R
authors.lastname: Kato
authors.affiliation: Department of Urology, Obihiro Kyokai Hospital, Obihiro, Hokkaido, Japan.
authors.forename: Yasuharu
authors.initials: Y
authors.lastname: Kunishima
authors.affiliation: Department of Urology, Sunagawa City Medical Center, Sunagawa, Hokkaido, Japan.
authors.forename: Fumiyasu
authors.initials: F
authors.lastname: Takei
authors.affiliation: Department of Urology, Saiseikai Otaru Hospital, Otaru, Hokkaido, Japan.
authors.forename: Hiroki
authors.initials: H
authors.lastname: Horita
authors.affiliation: Department of Urology, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan.
authors.forename: Naoya
authors.initials: N
authors.lastname: Masumori
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000932:Antiemetics / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects*; D000077608:Aprepitant; D002295:Carcinoma, Transitional Cell / Q000188:drug therapy*; D002945:Cisplatin / Q000008:administration & dosage / Q000009:adverse effects; D003841:Deoxycytidine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives; D003907:Dexamethasone / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005260:Female; D017829:Granisetron / Q000627:therapeutic use; D006801:Humans; D007546:Isoquinolines / Q000627:therapeutic use; D007680:Kidney Neoplasms / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D009025:Morpholines / Q000627:therapeutic use; D009325:Nausea / Q000139:chemically induced / Q000517:prevention & control*; D017294:Ondansetron / Q000627:therapeutic use; D000077924:Palonosetron; D011812:Quinuclidines / Q000627:therapeutic use; D012189:Retrospective Studies; D058831:Serotonin 5-HT3 Receptor Antagonists / Q000627:therapeutic use; D012702:Serotonin Antagonists / Q000627:therapeutic use*; D014516:Ureteral Neoplasms / Q000188:drug therapy; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy; D014571:Urologic Neoplasms / Q000188:drug therapy*; D014839:Vomiting / Q000139:chemically induced / Q000517:prevention & control*; D000093542:Gemcitabine
chemical_list: D000932:Antiemetics; D000077608:Aprepitant; D002945:Cisplatin; D003841:Deoxycytidine; D003907:Dexamethasone; D017829:Granisetron; D007546:Isoquinolines; D009025:Morpholines; D017294:Ondansetron; D000077924:Palonosetron; D011812:Quinuclidines; D058831:Serotonin 5-HT3 Receptor Antagonists; D012702:Serotonin Antagonists; D000093542:Gemcitabine
keywords: aprepitant; chemotherapy-induced nausea and vomiting; emesis; palonosetron; urothelial cancer