Delayed nausea and vomiting from carboplatin doublet chemotherapy

Area of Science:

• Oncology
• Clinical Pharmacology
• Patient Care

Background:

• Delayed chemotherapy-induced nausea and vomiting (CINV) is a significant challenge for cancer patients on carboplatin regimens.
• Standard antiemetic prophylaxis (5-HT3 antagonist and dexamethasone) is insufficient for preventing delayed CINV.
• This study aimed to determine the incidence and risk factors for delayed CINV.

Purpose of the Study:

• To define the incidence of delayed chemotherapy-induced nausea and vomiting (CINV) in patients receiving carboplatin-based chemotherapy.
• To identify risk factors associated with delayed CINV.
• To evaluate the impact of CINV on patients' quality of life using the Functional Living Index Emesis (FLIE) questionnaire.

Main Methods:

• A prospective study enrolled 105 newly diagnosed cancer patients receiving carboplatin chemotherapy (AUC 5 or above) without prophylactic aprepitant.
• The primary endpoint was the incidence of delayed CINV after Cycle 1.
• Patients completed FLIE questionnaires and underwent telephone interviews to assess CINV severity and need for breakthrough medications.

Main Results:

• Delayed CINV was observed in 30% of patients after Cycle 1, with incidence rates of 14.1% at 48 hours, 22.4% at 72 hours, and 23.5% at 96 hours.
• The incidence of delayed CINV decreased after Cycle 3 to 12.8% (48 hours), 14.6% (72 hours), and 16% (96 hours).
• Twenty percent of patients required breakthrough antiemetics during Cycle 1; no significant gender differences in CINV incidence were noted.

Conclusions:

• Approximately 30% of patients receiving carboplatin chemotherapy experience moderate to severe delayed CINV without prophylactic aprepitant.
• The findings highlight the need for improved antiemetic strategies to manage delayed CINV in this patient population.
• Further research may explore the efficacy of aprepitant or other novel agents in preventing delayed CINV.