Sustained antiemetic efficacy of fosnetupitant versus aprepitant in carboplatin-based chemotherapy: a retrospective...

Carboplatin (CBDCA) is highly emetogenic when administered at an area under the curve (AUC) ≥ 4, requiring triple antiemetic therapy, including an NK₁ receptor antagonist (NK₁ RA). Fosnetupitant (F-NTP), a long-acting NK₁ RA, may provide sustained receptor occupancy; however, its direct comparisons with aprepitant (APR) in CBDCA-based regimens between 0 and 168 h remain lacking. We aimed to evaluate the antiemetic efficacy of F-NTP versus APR during 1 week following chemotherapy.

This retrospective single-center observational study included patients with cancer receiving CBDCA (AUC ≥ 4)-based regimens. Propensity score matching was performed using clinical factors. The primary endpoint was the complete response (CR; no emesis or rescue medication) rate between 0 and 168 h. The secondary endpoints included phase-specific CR rates, time to treatment failure (TTF), and adverse events (AEs).

After matching, 242 patients were included in each group. The overall CR rate at 0-168 h was significantly higher with F-NTP (83.5%) than with APR (69.4%) (p < 0.001). F-NTP significantly prolonged TTF (hazard ratio = 0.48, 95% confidence interval: 0.33-0.71, p < 0.001). The multivariate analysis revealed female sex, younger age, and high CBDCA dose as significant risk factors for non-CR, while F-NTP use was a protective factor. AEs did not differ significantly between the groups and were mostly Grade 1.

F-NTP demonstrated superior antiemetic efficacy to that of APR in CBDCA-based regimens, particularly maintaining higher CR rates through the acute and delayed phases. F-NTP was also well tolerated, supporting its potential as a strong prophylactic agent for preventing chemotherapy-induced nausea and vomiting.