A phase 3, randomized, double-blind study of single-dose fosaprepitant for prevention of cisplatin-induced nausea and vomiting: results of an Indian population subanalysis

CONTEXT

Currently, there is limited data on the prevention of chemotherapy-induced nausea and vomiting (CINV) in Indian patients.

AIMS

This post hoc study assessed the efficacy and safety of fosaprepitant compared with aprepitant for prevention of CINV in the Indian population. A subgroup analysis was performed from data collected in a phase 3 study of intravenous (IV) fosaprepitant or oral aprepitant, plus the 5-HT 3 antagonist ondansetron and the corticosteroid dexamethasone, in cisplatin-naοve patients with solid malignancies.

MATERIALS AND METHODS

Patients scheduled to receive cisplatin (≥70 mg/m 2 ) were administered a single IV dose of fosaprepitant dimeglumine (150 mg) on day 1 or a 3-day dosing regimen of oral aprepitant (day 1:125 mg, days 2 and 3:80 mg) with standard doses of ondansetron and dexamethasone. Patients recorded nausea and/or vomiting episodes and their use of rescue medication and were monitored for adverse events (AEs) and tolerability.

STATISTICAL ANALYSIS USED

Differences in response rates between fosaprepitant and aprepitant were calculated using the Miettinen and Nurminen method.

RESULTS

In the Indian subpopulation (n = 372), efficacy was similar for patients in both the fosaprepitant or aprepitant groups; complete response in the overall, acute, and delayed phases and no vomiting in all phases were approximately 4 percentage points higher in the fosaprepitant group compared with the aprepitant group. Fosaprepitant was generally well-tolerated; common AEs were similar to oral aprepitant.

CONCLUSIONS

IV fosaprepitant is as safe and effective as oral aprepitant in the Indian subpopulation and offers an alternative to the oral formulation.

History of trace gases in presolar diamonds inferred from ion-implantation experiments

Diamond grains are the most abundant presolar grains found in primitive meteorites. They formed before the Solar System, and therefore provide a record of nuclear and chemical processes in stars and in the interstellar medium. Their origins are inferred from the unusual isotopic compositions of trace elements-mainly xenon-which suggest that they came from supernovae. But the exact nature of the sources has been enigmatic, as has the method by which noble gases were incorporated into the grains. One observation is that different isotopic components are released at different temperatures when the grains are heated, and it has been suggested that these components have different origins. Here we report results of a laboratory study that shows that ion implantation (previously suggested on other grounds) is a viable mechanism for trapping noble gases. Moreover, we find that ion implantation of a single isotopic composition can produce both low- and high-temperature release peaks from the same grains. We conclude that both isotopically normal and anomalous gases may have been implanted by multiple events separated in space and/or time, with thermal processing producing an apparent enrichment of the anomalous component in the high-temperature release peak. The previous assumption that the low- and high-temperature components were not correlated may therefore have led to an overestimate of the abundance of anomalous argon and krypton, while obscuring an enhancement of the light-in addition to the heavy-krypton isotopes.