WCLC 2018 — Lung cancer: aprepitant-based therapy quells CINV in Chinese study


  • Brian Hoyle
  • Univadis
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Takeaway

  • A phase 3 study involving >300 patients with lung cancer has demonstrated the efficacy of combination aprepitant, palonosetron, and dexamethasone in curbing chemotherapy-induced nausea and vomiting (CINV).

Why this matters

  • Chemotherapy is a common treatment for lung cancer.
  • The treatment can cause nausea and vomiting.
  • The adverse effects can result in treatment discontinuation.

Study design

  • Randomized, placebo-controlled study.
  • 324 patients with locally advanced or metastatic lung cancer screened.
  • Patients had received full-dose, single-day, cisplatin-based chemotherapy.
  • 244 patients randomly assigned 1:1 to aprepitant+palonosetron+dexamethasone (n=122) or placebo+palonosetron+dexamethasone (n=122).
  • Primary endpoint: complete response of nausea and vomiting in first cycle of treatment (2 cycles total).
  • Secondary endpoints: prevalence of nausea and vomiting, rescue antiemetic medication, response of cross-over patients, safety.
  • Cross-over allowed after cycle 2 of treatment for patients in placebo group.
  • Significance at P<.05>
  • Funded internally.

Key results

  • Groups balanced at baseline
  • Complete response in 92.6% and 79.5% of patients in the treatment and control groups, respectively (P<.01>
  • Resolution of nausea in 75.4% and 71.3% of patients in the treatment and control groups, respectively (P>.05)
  • Continued nausea and vomiting second cycle in the treatment group, at 37.5% and 25%, respectively; both were 100% in control (P<.05 for nausea and vomiting>
  • Rescue medications were used for 14.7% and 36.1% of patients in the treatment and control groups, respectively (P<.001>
  • Cross-over of 32 patients in the placebo group for rescue treatment for vomiting (n=16) or nausea (n=16)
  • Study groups comparable for adverse events, including decreased appetite, fatigue, diarrhea, and abdominal pain

Expert comment

  • "Aprepitant plus palonosetron and dexamethasone proved to be effective and well tolerated in preventing chemotherapy-induced nausea and vomiting after administration of full-dose, single-day cisplatin-based combination chemotherapy," said presenter Fang Wu, MS, Hunan Cancer Hospital, Xiangya School of Medicine, Changshu, China.