NEW YORK (Reuters Health) - The addition of the drug aprepitant to other antiemetic therapy is associated with less nausea and vomiting during an initial cycle of chemotherapy, and the response is maintained well during subsequent cycles, investigators report. Full response rates were higher for aprepitant than for standard therapy throughout all cycles (p = 0.006 or less).

The efficacy of treatment with a serotonin-3 receptor antagonist and a corticosteroid in preventing emesis wanes over multiple cycles of cisplatin-based chemotherapy, Dr. R. de Wit and associates explain in the European Journal of Cancer for February. Phase II studies showed that adding aprepitant, a neurokinin-1 receptor antagonist, prevents acute and delayed nausea and vomiting caused by initial and repeat chemotherapy. (See Reuters Health report, October 15, 2003.)

Dr. de Wit at Erasmus University Medical Center in Rotterdam, The Netherlands, and associates employed a statistical approach that takes into account attrition rates and variable responses between cycles to analyze the combined results of two phase III trials. Patients were treated with ondansetron and dexamethasone, and randomized to treatment with or without aprepitant.

A total of 1099 patients participated in a first cycle of chemotherapytant group and 145 in the standard therapy group completing six cycles. Success was defined as no emesis and no significant nausea on the first five days of each cycle.

In the first cycle, 61% of those in the aprepitant group responded, compared with 46% of those in the standard therapy group. Those figures averaged 59% and 40%, respectively, throughout future cycles. Treatment failure occurred in 36.3% and 51.2%, respectively.

"The addition of aprepitant to standard antiemetic therapy represents an important advance in supportive care for patients receiving multiple cycles of highly emetogenic chemotherapy," Dr. de Wit's group concludes.

Eur J Cancer 2004;40:403-410.

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