Karin Jordan1, David G Warr2, Axel Hinke3, Linda Sun4, Paul J Hesketh5. 1. Department of Internal Medicine IV, Hematology/Oncology, Martin-Luther- University Halle-Wittenberg, Ernst-Grube-Strasse 40, 06120, Halle, Germany. karin.jordan@uk-halle.de. 2. Princess Margaret Hospital, 610 University Avenue, Toronto, M5G 2M9, Canada. 3. WiSP Wissenschaftlicher Service Pharma GmbH, Karl-Benz-Strasse 1, D-40764, Langenfeld, Germany. 4. Merck & Co., Inc., 2000 Galloping Hill Rd, Kenilworth, NJ, 07033, USA. 5. Department of Hematology Oncology, Lahey Hospital & Medical Center, 41 Mall Road, Burlington, MA, 01805, USA.
Abstract
PURPOSE: This meta-analysis was performed to evaluate the efficacy of neurokinin-1 receptor antagonists (NK1RAs) for the prevention of chemotherapy-induced nausea and vomiting (CINV) across different categories of chemotherapeutic emetogenicity. METHODS: A systematic review of MEDLINE (via PubMed) and OVID databases, plus major oncology conferences, identified randomized, controlled trials evaluating NK1RAs in combination with a 5-HT3 RA plus a glucocorticoid for management of CINV. Efficacy end points were no emesis, no nausea, and complete response (CR) rates. Data were analyzed using a random effects model. RESULTS: Twenty-three trials (N = 11,814) were identified. Based on absolute differences (AD) for no emesis (21 %), no nausea (8 %), CR (16 %), and odd ratios (OR) of 2.62, 1.43, and 2.16, respectively, NK1RA regimens provided better CINV protection versus control groups (all p < 0.00001) in patients receiving cisplatin-based highly emetogenic chemotherapy (HEC). In patients receiving anthracycline/cyclophosphamide (AC)-based HEC, respective ADs and ORs were 14, 4, and 11 % and 1.97 (p < 0.0001), 1.17 (p = 0.04), and 1.62 (p < 0.00001). In patients receiving moderately emetogenic chemotherapy (3 trials), no statistically significant benefit of NK1RAs was found; however, positive trends were detected for CR and no emesis. NK1RAs were effective for CINV prevention in a small number of studies using high-dose chemotherapy as conditioning prior to stem cell transplant and cisplatin-based multiple-day chemotherapy (MDC). CONCLUSIONS: This meta-analysis demonstrated the efficacy of NK1RA in preventing vomiting in patients receiving HEC (including AC), with smaller effects on prevention of nausea. Efficacy is also seen with high-dose chemotherapy and cisplatin-based MDC.
PURPOSE: This meta-analysis was performed to evaluate the efficacy of neurokinin-1 receptor antagonists (NK1RAs) for the prevention of chemotherapy-induced nausea and vomiting (CINV) across different categories of chemotherapeutic emetogenicity. METHODS: A systematic review of MEDLINE (via PubMed) and OVID databases, plus major oncology conferences, identified randomized, controlled trials evaluating NK1RAs in combination with a 5-HT3 RA plus a glucocorticoid for management of CINV. Efficacy end points were no emesis, no nausea, and complete response (CR) rates. Data were analyzed using a random effects model. RESULTS: Twenty-three trials (N = 11,814) were identified. Based on absolute differences (AD) for no emesis (21 %), no nausea (8 %), CR (16 %), and odd ratios (OR) of 2.62, 1.43, and 2.16, respectively, NK1RA regimens provided better CINV protection versus control groups (all p < 0.00001) in patients receiving cisplatin-based highly emetogenic chemotherapy (HEC). In patients receiving anthracycline/cyclophosphamide (AC)-based HEC, respective ADs and ORs were 14, 4, and 11 % and 1.97 (p < 0.0001), 1.17 (p = 0.04), and 1.62 (p < 0.00001). In patients receiving moderately emetogenic chemotherapy (3 trials), no statistically significant benefit of NK1RAs was found; however, positive trends were detected for CR and no emesis. NK1RAs were effective for CINV prevention in a small number of studies using high-dose chemotherapy as conditioning prior to stem cell transplant and cisplatin-based multiple-day chemotherapy (MDC). CONCLUSIONS: This meta-analysis demonstrated the efficacy of NK1RA in preventing vomiting in patients receiving HEC (including AC), with smaller effects on prevention of nausea. Efficacy is also seen with high-dose chemotherapy and cisplatin-based MDC.
Entities:
Keywords:
Antiemetics; Chemotherapy-induced nausea and vomiting; Emetogenicity; Neurokinin-1 receptor
Authors: F Roila; J Herrstedt; M Aapro; R J Gralla; L H Einhorn; E Ballatori; E Bria; R A Clark-Snow; B T Espersen; P Feyer; S M Grunberg; P J Hesketh; K Jordan; M G Kris; E Maranzano; A Molassiotis; G Morrow; I Olver; B L Rapoport; C Rittenberg; M Saito; M Tonato; D Warr Journal: Ann Oncol Date: 2010-05 Impact factor: 32.976
Authors: Ethan Basch; Ann Alexis Prestrud; Paul J Hesketh; Mark G Kris; Petra C Feyer; Mark R Somerfield; Maurice Chesney; Rebecca Anne Clark-Snow; Anne Marie Flaherty; Barbara Freundlich; Gary Morrow; Kamakshi V Rao; Rowena N Schwartz; Gary H Lyman Journal: J Clin Oncol Date: 2011-09-26 Impact factor: 44.544
Authors: D Campos; J R Pereira; R R Reinhardt; C Carracedo; S Poli; C Vogel; J Martinez-Cedillo; A Erazo; J Wittreich; L O Eriksson; A D Carides; B J Gertz Journal: J Clin Oncol Date: 2001-03-15 Impact factor: 44.544
Authors: Sant P Chawla; Steven M Grunberg; Richard J Gralla; Paul J Hesketh; Cindy Rittenberg; Mary E Elmer; Carrie Schmidt; Arlene Taylor; Alexandra D Carides; Judith K Evans; Kevin J Horgan Journal: Cancer Date: 2003-05-01 Impact factor: 6.860
Authors: Paul J Hesketh; Steven M Grunberg; Richard J Gralla; David G Warr; Fausto Roila; Ronald de Wit; Sant P Chawla; Alexandra D Carides; Juliana Ianus; Mary E Elmer; Judith K Evans; Klaus Beck; Scott Reines; Kevin J Horgan Journal: J Clin Oncol Date: 2003-10-14 Impact factor: 44.544
Authors: Sergio Poli-Bigelli; Jose Rodrigues-Pereira; Alexandra D Carides; Guoguang Julie Ma; Krista Eldridge; Anita Hipple; Judith K Evans; Kevin J Horgan; Francesca Lawson Journal: Cancer Date: 2003-06-15 Impact factor: 6.860
Authors: H J Schmoll; M S Aapro; S Poli-Bigelli; H-K Kim; K Park; K Jordan; J von Pawel; H Giezek; T Ahmed; C Y Chan Journal: Ann Oncol Date: 2006-03-08 Impact factor: 32.976
Authors: R M Navari; R R Reinhardt; R J Gralla; M G Kris; P J Hesketh; A Khojasteh; H Kindler; T H Grote; K Pendergrass; S M Grunberg; A D Carides; B J Gertz Journal: N Engl J Med Date: 1999-01-21 Impact factor: 91.245
Authors: Karin Jordan; Luisa Blättermann; Axel Hinke; Carsten Müller-Tidow; Franziska Jahn Journal: Support Care Cancer Date: 2017-08-31 Impact factor: 3.603