ORLANDOWhen combined with standard antiemetic therapy, the neurokinin-1 (NK1) receptor antagonist aprepitant (MK-869[M]) protects against acute and delayed chemotherapy-induced nausea and vomiting, according to two separate studies (ASCO abstracts 1467 and 1467).
"We have been working with NK1 antagonists for over a decade, but until now, there really were no new agents.
Now we have a once-daily oral agent that adds to existing medications," Ronald de Wit, MD, PhD, told Oncology News International. He is director of the inpatient department of medical oncology at Rotterdam Cancer Institute and Erasmus Medical Center of University Hospital in Rotterdam, the Netherlands. "In phase III clinical studies, aprepitant added 10% to 15% to emesis relief in the early phase and about 25% in the later phase, at days 2 to 5 after the start of chemotherapy," Dr. de Wit explained.
Before Cisplatin(Drug information on cisplatin) Therapy
Before receiving their first dose of a chemotherapy regimen including cisplatin (Platinol) greater than 70 mg/m², 202 patients between ages 20 and 82 were randomized to one of three treatment groups. Group I received aprepitant, 375 mg on day 1 and 250 mg on days 2 to 5. Group II received aprepitant, 125 mg on day 1 and 80 mg on days 2 to 5. Group III received placebo on days 1 to 5.
All patients received standard antiemetic therapy with intravenous ondansetron(Drug information on ondansetron) (Zofran) at 32 mg, and oral dexamethasone(Drug information on dexamethasone) (Decadron) at 20 mg, before receiving cisplatin on day 1, and dexamethasone on days 2 to 5. Because of pharmacokinetic data from healthy volunteers, the group I regimen was discontinued, and efficacy evaluations were based on only groups II and III.
Compared with standard therapy alone, triple combination therapy including aprepitant provided 34% better protection against chemotherapy-induced nausea and vomiting throughout multiple chemotherapy cycles. Although standard therapy decreased in efficacy after three cycles, the triple combination regimen maintained efficacy during all six cycles.