Antiemetic Efficacy of Aprepitant in Cisplatin-Gemcitabine Therapy for Biliary Tract Cancer: A Multicenter Study

Chemotherapy-induced nausea and vomiting (CINV) is a significant issue among the adverse events associated with chemotherapy, and the management of nausea remains inadequate. Although international guidelines classify gemcitabine plus cisplatin (GC) therapy as having a high emetogenic risk, Japanese guidelines categorize it as moderate risk. This study aimed to evaluate the effects of aprepitant as a prophylactic antiemetic in conjunction with GC therapy for biliary tract cancer in a real-world setting.

This retrospective study was conducted at 12 hospitals in Japan. Patients who received their first cycle of GC therapy between January 2012 and June 2023 were included. Propensity-score matching was used to adjust for differences in the baseline patient characteristics. The primary endpoint was the total control (TC) rate in the delayed phase, which was defined as 24-120 h post chemotherapy.

After propensity-score matching, 129 patients were included in each group. The TC rates in the delayed phase and overall (0-168 h) were significantly higher in the aprepitant group than in the non-aprepitant group (90.7% vs. 71.3%, p<0.001 and 88.4% vs. 65.9%, p<0.001, respectively). The rates of nausea and vomiting of any grade were significantly lower in the aprepitant group than in the non-aprepitant group (11.6% vs. 33.3%, p<0.01 and 0% vs. 7.0%, p<0.01, respectively).

The addition of aprepitant significantly improves the delayed-phase TC rate by approximately 20%. These findings suggest the significance of aprepitant in the management of CINV during GC therapy.