EFFICACY OF TRIPLET ANTIEMETIC THERAPY FOR CHEMOTHERAPY-INDUCED NAUSEA AND VOMITING IN LUNG CANCER PATIENTS RECEIVING HIGHLY EMETOGENIC CHEMOTHERAPY: PALONOSETRON, APREPITANT, AND DEXAMETHASONE

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Abstract

Background

Chemotherapy-induced nausea and vomiting (CINV) is one of the most problematic symptoms experienced by patients undergoing cancer treatments. Triplet therapy with palonosetron (PALO), aprepitant (APR), and dexamethasone (DEX) is a guideline-recommended antiemetic prophylaxis for highly emetogenic chemotherapy (HEC). However, the efficacy and safety of this therapy for lung cancer patients has not yet been well investigated.

Methods

Chemotherapy naïve lung cancer patients scheduled to receive HEC were enrolled in this study. The eligible patients were pretreated with the triplet therapy (PALO 0.75 mg day 1, APR 125 mg day 1 and 80 mg day 2–3, DEX 9.9 mg day 1 and 8 mg day 2–4) before receiving HEC. The efficacy and safety of these substances were assessed during an observation period starting from the administration of HEC up to 120 h. A questionnaire diary documented patients' complaints. The primary end point was the proportion of the patients who did not experience emesis or rescue antiemetic (Complete Response rate; CR rate) during any part of the whole observation period. The secondary end points were (i) the CR rate during the acute phase (0–24 h) and the late phase (24–120 h), (ii) the proportion of patients who experienced no emetic episodes and significant nausea with no rescue medication (Complete Control rate; CC rate), and (iii) safety.

Results

A total of 72 patients were enrolled with 54 assessable patients at the time of submission. The median age was 63.5 years. The CR rate during the whole observation period, the acute phase and the late phase was 77.8%, 94.8% and 79.6%, respectively. The CC rate in the late phase was 63.5%. No severe side-effects were observed.

Conclusion

Triplet therapy using PALO, APR and DEX was shown to be safe and effective in preventing CINV with high CR rates in lung cancer patients treated with HEC. Further investigation is needed to reduce nausea in the late phase.

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