Efficacy of aprepitant in management of chemotherapy-induced nausea and vomiting

Chemotherapy-induced nausea and vomiting (CINV) is an important cause of distress for cancer patients. We have evaluated the effectiveness and safety of a new antiemetic aprepitant in improving management of CINV refractory to standard antiemetic therapy in the general oncology setting.

Retrospective chart review of all patients who received aprepitant from 1 January 2004 to 31 May 2005.

Twenty-six patients received oral aprepitant in addition to 5-hydroxytryptamine blocker and corticosteroid. Eighty-five per cent of the patients were women. Median age was 49 years. More than half patients had early-stage cancers. Majority received anthracycline-based chemotherapy for breast cancer. Fourteen (54%) patients received aprepitant during cycle 2, seven patients (27%) started aprepitant during cycle 4 and one (4%) during cycle 5. Side-effects observed included constipation (27%), fatigue (27%) and diarrhoea (8%). Six (23%) patients did not complete chemotherapy. Two of these had persistent nausea and vomiting, and four experienced diarrhoea, febrile neutropenia and other chemotherapy-related events. Three patients (12%) were hospitalized prior to starting aprepitant because of CINV, and one patient was hospitalized because of CINV while receiving aprepitant. Only six (23%) patients would have been eligible for aprepitant under the reimbursement scheme available at the time.

The addition of aprepitant was associated with improved control of nausea and vomiting and reduction in hospitalization in patients receiving chemotherapy.