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Addition of Aprepitant Reduced Chemotherapy-Induced Nausea and Vomiting
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Journal of Clinical Oncology
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
Aprepitant, Granisetron, and Dexamethasone for Prevention of Chemotherapy-Induced Nausea and Vomiting After High-Dose Melphalan in Autologous Transplantation for Multiple Myeloma: Results of a Randomized, Placebo-Controlled Phase III Trial
J. Clin. Oncol 2014 Oct 20;32(30)3413-20, T Schmitt, H Goldschmidt, K Neben, A Freiberger, J Hüsing, M Gronkowski, M Thalheimer, le H Pelzl, G Mikus, J Burhenne, AD Ho, G EgererFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
While antiemetic guidelines are by now very well established for all forms of standard intravenous and oral chemotherapy, there has been a paucity of research on best regimens and schedules of prophylactic drugs in the high-dose, stem cell conditioning arena. This randomized, placebo controlled study evaluating the addition of aprepitant to a regimen of granisetron and dexamethasone prior to high-dose melphalan is therefore very welcome.
The authors found that complete response, as typically defined in chemotherapy-induced nausea and vomiting (CINV) studies, was higher in the patients on the aprepitant-containing regimen (58% vs 41%; OR = 1.92). Not surprisingly, these rates are substantially lower than those for non–high dose highly emetogenic chemotherapy. Other endpoints favored aprepitant as well.
In order to minimize the toxicity of stem cell transplant, additional trials are highly encouraged in this patient population. With the advent of newer HT-3 antagonists, new NK-1 antagonists, and novel combinations, such studies are quite desirable and offer the promise of better CINV control.