Evaluation of optimal prophylactic antiemetic regimens for doxorubicin-cyclophosphamide chemotherapy
Invited conference paper presented and published in conference proceedings


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AbstractBackground: Chemotherapy-induced nausea and vomiting (CINV) is common with doxorubicin-cyclophosphamide (AC) chemotherapy. Recommended antiemetic regimens may incorporate neurokinin-1 receptor antagonist (NK1RA), 5-hydroxytryptamine type-3 receptor antagonist (5HT3RA), corticosteroid and dopamine antagonist. This post-hoc analyses compared 5 different antiemetic regimens which were tested in 3 prospective antiemetic studies among Chinese breast cancer patients who received (neo)adjuvant AC. The primary objective was to compare efficacies of doublet (5HT3RA/dexamethasone) with triplet antiemetic regimens (NK1RA/ 5HT3RA/dexamethasone) with/without olanzapine. The secondary objectives were to compare (1) netupitant- with aprepitant-based triplet antiemetic regimens; and (2) 1-day (D1) versus 3-day (D1–3) dexamethasone.
Methods: 304 patients were included: Group 1, ondansetron/dexamethasone (D1); Group 2, aprepitant/ondansetron/dexamethasone (D1); Group 3, aprepitant/ondansetron/dexamethasone (D1-3); Group 4, aprepitant/ondansetron/dexamethasone (D1-3)/olanzapine; Group 5, netupitant/palonosetron/dexamethasone (D1-3). Analyses were conducted on rates of Complete Response (CR; defined as ‘no vomiting with no rescue therapy’) and quality of life (QOL).
Results: CR rates in overall phase of cycle 1 AC were: Groups 1 vs 3 were 41.9% vs 38.3% (p = 0.6849); Groups 1 vs 4 were 41.9% vs 65.0% (p = 0.0107); Groups 1 vs 5 were 41.9% vs 60.0% (p = 0.0460); these were associated with better QOL. CR rates of Groups 3 vs 5 were 38.3% vs 60.0% (p = 0.0176); QOL was better in Group 5. CR rates of Groups 2 vs 3 were 46.8% vs 38.3% (p = 0.3459); QOL was significantly worse in Group 3.
Conclusion: Among Chinese patients who were uniformly receiving AC, aprepitant-containing triplets was not superior to doublet antiemetic regimen, while netupitant-containing triplets and the addition of olanzapine to aprepitant-containing triplets were superior to doublets. Netupitant/palonosetron/dexamethasone was superior to aprepitant/ondansetron/dexamethasone triplets. Protracted administration of dexamethasone provided limited additional benefit.
Acceptance Date02/10/2020
All Author(s) ListW Yeo, L Li, T. Lau, K Lai, V Chan, K Wong, C Yip, E Pang, M. Cheung, V Chan, C Kwok, J Suen, F Mo
Name of Conference12th European Breast Cancer Conference (EBCC-12)
Start Date of Conference02/10/2020
End Date of Conference03/10/2020
Place of ConferenceVirtual
Country/Region of ConferenceSpain
Proceedings TitleEuropean Journal of Cancer
Year2020
Month10
Volume Number138
Issue NumberSuppl 1
PublisherElsevier
PagesS123 - S123
ISSN0959-8049
eISSN1879-0852
LanguagesEnglish-United Kingdom

Last updated on 2022-10-01 at 23:30