Efficacy of Aprepitant in Patients with Advanced or Recurrent Lung Cancer Receiving Moderately Emetogenic Chemotherapy

  • Uchino, Junji ;
  • Hirano, Ryosuke ;
  • Tashiro, Naoki ;
  • Yoshida, Yuji ;
  • Ushijima, Shinichiro ;
  • Matsumoto, Takemasa ;
  • Ohta, Keiichi ;
  • Nakatomi, Keita ;
  • Takayama, Koichi ;
  • Fujita, Masaki ;
  • Nakanishi, Yoichi ;
  • Watanabe, Kentaro
  • Published : 2012.08.31


Aims and Background: To evaluate the efficacy of a combination of aprepitant and conventional antiemetic therapy in patients with advanced or recurrent lung cancer receiving moderately emetogenic chemotherapy (MEC). Methods: Patients with advanced or recurrent lung cancer who were treated with MEC regimens at the Department of Respiratory Medicine, Fukuoka University Hospital, were included and classified into the following groups: control group (treatment: 5-HT3 receptor antagonists + dexamethasone) and aprepitant group (treatment: 5-HT3 receptor antagonists + dexamethasone + aprepitant). The presence or absence of chemotherapy-induced nausea and vomiting (CINV) was evaluated according to the Common Terminology Criteria for Adverse Events (CTCAE) v4.0; patients with grade 1 or above were considered positive for CINV. Food intake per day, completion of planned chemotherapy, and progression-free survival (PFS) achieved by chemotherapy were investigated. Results: The complete suppression rate of nausea in the aprepitant group was significantly higher than that in the control group (p = 0.0043). Throughout the study, the food intake in the aprepitant group was greater than that in the control group, with the rate being significantly higher, in particular, on day 5 (p = 0.003). The completion rate of planned chemotherapy was also higher in the aprepitant group (p = 0.042). PFS did not differ significantly, but tended to be improved in the aprepitant group. Conclusions: The aprepitant group showed significantly higher complete suppression of nausea, food intake on day 5, and completion of planned chemotherapy than the control group.


CINV;aprepitant;complete suppression rate of nausea;food intake


  1. Andrykowski MA (1988). Defining anticipatory nausea and vomiting: differences among cancer chemotherapy patients who report pretreatment nausea. J Behav Med, 11, 59-69.
  2. Basch E, Prestrud AA, Hesketh PJ, et al (2011). Antiemetics: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol, 29, 4189-98.
  3. de Wit R, Herrstedt J, Rapoport B, et al (2004). The oral NK(1) antagonist, aprepitant, given with standard antiemetics provides protection against nausea and vomiting over multiple cycles of cisplatin-based chemotherapy: a combined analysis of two randomised, placebo-controlled phase III clinical trials. Eur J Cancer, 40, 403-10.
  4. Ettinger DS, Bierman PJ, Bradbury B, et al (2007). Antiemesis. J Natl Compr Canc Netw, 5, 12-33.
  5. Hesketh PJ, Grunberg SM, Gralla RJ, et al (2003). The oral neurokinin-1 antagonist aprepitant for the prevention of chemotherapy-induced nausea and vomiting: a multinational, randomized, double-blind, placebo-controlled trial in patients receiving high-dose cisplatin--the Aprepitant Protocol 052 Study Group. J Clin Oncol, 21, 4112-9.
  6. Huskey SE, Dean BJ, Bakhtiar R, et al (2003). Brain penetration of aprepitant, a substance P receptor antagonist, in ferrets. Drug Metab Dispos, 31, 785-91.
  7. Jordan K, Hinke A, Grothey A, et al (2007). A meta-analysis comparing the efficacy of four 5-HT3-receptor antagonists for acute chemotherapy-induced emesis. Support Care Cancer, 15, 1023-33.
  8. Kris MG, Hesketh PJ, Somerfield MR, et al (2006). American Society of Clinical Oncology guideline for antiemetics in oncology: update 2006. J Clin Oncol, 24, 2932-47.
  9. Morrow GR, Lindke J, Black PM (1991). Predicting development of anticipatory nausea in cancer patients: prospective examination of eight clinical characteristics. J Pain Symptom Manage, 6, 215-23.
  10. Morrow GR, Morrell C (1982). Behavioral treatment for the anticipatory nausea and vomiting induced by cancer chemotherapy. N Engl J Med, 307, 1476-80.
  11. Navari RM (2009a). Antiemetic control: toward a new standard of care for emetogenic chemotherapy. Expert Opin Pharmacother, 10, 629-44.
  12. Navari RM (2009b). Pharmacological management of chemotherapy-induced nausea and vomiting: focus on recent developments. Drugs, 69, 515-33.
  13. Perez EA, Hesketh P, Sandbach J, et al (1998). Comparison of single-dose oral granisetron versus intravenous ondansetron in the prevention of nausea and vomiting induced by moderately emetogenic chemotherapy: a multicenter, double-blind, randomized parallel study. J Clin Oncol, 16, 754-60.
  14. Poli-Bigelli S, Rodrigues-Pereira J, Carides AD, et al (2003). Addition of the neurokinin 1 receptor antagonist aprepitant to standard antiemetic therapy improves control of chemotherapy-induced nausea and vomiting. Results from a randomized, double-blind, placebo-controlled trial in Latin America. Cancer, 97, 3090-8.
  15. Rapoport BL, Jordan K, Boice JA, et al (2010). Aprepitant for the prevention of chemotherapy-induced nausea and vomiting associated with a broad range of moderately emetogenic chemotherapies and tumor types: a randomized, double-blind study. Support Care Cancer, 18, 423-31.
  16. Richardson JL, Marks G, Levine A (1988). The influence of symptoms of disease and side effects of treatment on compliance with cancer therapy. J Clin Oncol, 6, 1746-52.
  17. Roila F, Herrstedt J, Aapro M, et al (2010). Guideline update for MASCC and ESMO in the prevention of chemotherapyand radiotherapy-induced nausea and vomiting: results of the Perugia consensus conference. Ann Oncol, 21, v232-43.
  18. Rojas C, Stathis M, Thomas AG, et al (2008). Palonosetron exhibits unique molecular interactions with the 5-HT3 receptor. Anesth Analg, 107, 469-78.
  19. Saito M, Aogi K, Sekine I, et al (2009). Palonosetron plus dexamethasone versus granisetron plus dexamethasone for prevention of nausea and vomiting during chemotherapy: a double-blind, double-dummy, randomised, comparative phase III trial. Lancet Oncol, 10, 115-24.
  20. Takeuchi H, Saeki T (2010). An antiemetic guideline for patients with malignancies in Japan. Gan To Kagaku Ryoho, 37, 976-9 (in Japanese).
  21. Vardy J, Chiew KS, Galica J, Pond GR, Tannock IF (2006). Side effects associated with the use of dexamethasone for prophylaxis of delayed emesis after moderately emetogenic chemotherapy. Br J Cancer, 94, 1011-5.
  22. Wong EH, Clark R, Leung E, et al (1995). The interaction of RS 25259-197, a potent and selective antagonist, with 5-HT3 receptors, in vitro. Br J Pharmacol, 114, 851-9.

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