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Sharma V, Kumar A, Baa A, Kirar S, Sharma A, Bakhshi S, Gogia A, Malik PS, Rastogi S, Batra A, Pushpam D, Kataria B, Sagiraju H, Sharma A, Singh V. Dexamethasone-free antiemetic strategy for highly emetogenic chemotherapy: safety and efficacy-pilot study. BMJ Support Palliat Care 2024; 13:e867-e871. [PMID: 36927873 DOI: 10.1136/spcare-2022-003864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 02/28/2023] [Indexed: 03/18/2023]
Abstract
OBJECTIVES Dexamethasone sparing strategies have shown success. The feasibility of a dexamethasone-free antiemetic strategy remains undetermined. A prospective, single-arm, pilot study was planned to determine the efficacy of an olanzapine-based, dexamethasone-free, three-drug antiemetic regimen. METHODS Chemotherapy naïve, adult patients (≥18 years) who received ondansetron, aprepitant and olanzapine during the first cycle of highly emetogenic chemotherapy were enrolled. The primary endpoint was the rate of complete response (CR: no vomiting and no use of rescue medications) during the overall period (0-120 hours). RESULTS Out of the total of 101 patients enrolled, most were women (82%) and received anthracycline cyclophosphamide (73%) combination therapy. The rate of CR for the overall period was 65% (95% CI 55.2% to 74.5%). The rate of CR for the acute and delayed period was 79% (95% CI 70% to 86.7%) and 76% (95% CI 66.7% to 84.1%). The rate of nausea control rates for the acute, delayed and overall periods were 34%, 29% and 24%, respectively. The grade I, II and III sedation rates over the 5 days were 8%, 5% and 1%, respectively. CONCLUSIONS The dexamethasone-free antiemetic strategy showed modest efficacy with low incidence of clinically significant somnolence. There is a need to prospectively investigate the role of dexamethasone in the era of newer potent antiemetics in a randomised fashion. TRIAL REGISTRATION NUMBER CTRI/2021/07/034813.
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Affiliation(s)
- Vinod Sharma
- Department of Medical Oncology, National Cancer Institute, Jhajjar, Haryana, India
| | - Akash Kumar
- Department of Medical Oncology, National Cancer Institute, Jhajjar, Haryana, India
| | - Annie Baa
- Department of Medical Oncology, Dr B.R.A IRCH, AIIMS, New Delhi, India
| | - Sudhir Kirar
- Department of Medical Oncology, Dr B.R.A IRCH, AIIMS, New Delhi, India
| | - Atul Sharma
- Department of Medical Oncology, Dr B.R.A IRCH, AIIMS, New Delhi, India
| | - Sameer Bakhshi
- Department of Medical Oncology, Dr B.R.A IRCH, AIIMS, New Delhi, India
| | - Ajay Gogia
- Department of Medical Oncology, Dr B.R.A IRCH, AIIMS, New Delhi, India
| | | | - Sameer Rastogi
- Department of Medical Oncology, Dr B.R.A IRCH, AIIMS, New Delhi, India
| | - Atul Batra
- Department of Medical Oncology, Dr B.R.A IRCH, AIIMS, New Delhi, India
| | - Deepam Pushpam
- Department of Medical Oncology, Dr B.R.A IRCH, AIIMS, New Delhi, India
| | - Babita Kataria
- Department of Medical Oncology, National Cancer Institute, Jhajjar, Haryana, India
| | - Hari Sagiraju
- Department of Preventive Oncology, National Cancer Institute, Jhajjar, Haryana, India
| | - Aparna Sharma
- Department of Medical Oncology, Dr B.R.A IRCH, AIIMS, New Delhi, India
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Eghbali A, Kohpar FK, Ghaffari K, Afzal RR, Eghbali A, Ghasemi A. Evaluating Aprepitant single-dose plus granisetron and dexamethasone in children receiving highly emetogenic chemotherapy for the prevention of chemotherapy-induced nausea and vomiting: A triple-blinded randomized clinical trial. Hematol Transfus Cell Ther 2023; 45:281-289. [PMID: 35428609 PMCID: PMC10499563 DOI: 10.1016/j.htct.2022.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 01/15/2022] [Accepted: 02/13/2022] [Indexed: 10/18/2022] Open
Abstract
INTRODUCTION This study was performed to evaluate the degree of 3-day chemotherapy-induced nausea and vomiting (CINV) in children with cancer who received highly emetogenic chemotherapy (HEC) to ascertain the efficacy of aprepitant single-dose on dayL 1 plus granisetron and dexamethasone (DEX). METHODS This clinical trial study was conducted on 120 patients in the age range of 5 to 18 years old who received chemotherapy. Patients were divided into two groups; Group A received aprepitant at 125 mg/kg on day 1 orally, followed by 80 mg/kg daily on days 2 and 3 and Group B received a single dose of aprepitant 125 mg/kg on day 1 orally and placebo on days 2 and 3. All groups received granisetron 3 mg/m2 on day 1 and DEX on days 1 to 3. The primary and secondary endpoints were to evaluate the proportion of patients with acute, delayed and overall CINV within each group. RESULTS There were no significant differences between the two groups for vomiting, nausea or the use of rescue therapy. The number of patients without vomiting on day 1 was similar in both groups (96.5% vs. 98.3%, respectively; p = 0.848). CONCLUSION According to the results of this study, a single dose of aprepitant 125 mg/kg was as effective as administering three doses of aprepitant on 3 days. Therefore, the use of a single dose of aprepitant in combination with other standard treatment regimens to prevent CINV in children who received HEC was safe and efficacious and can be beneficial.
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Affiliation(s)
- Aziz Eghbali
- Clinical Research Development Center of Aliasghar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | | | - Kazem Ghaffari
- Department of Base and Laboratory Sciences, Khomein University of Medical Sciences, Khomein, Iran; Molecular and Medicine Research Center, Khomein University of Medical Sciences, Khomein, Iran
| | | | | | - Ali Ghasemi
- Department of Biochemistry and Hematology, Semnan University of Medical Sciences, Semnan, Iran; Cancer Research Center, Semnan University of Medical Sciences, Semnan, Iran.
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Hu M, Yao L, Li L, Han Y, Wang Y, Lei Z, Wu H. Therapeutic effect of low frequency electric pulse therapy on cisplatin-based chemotherapy-induced nausea and vomiting in patients with lung adenocarcinoma: A prospective controlled study. Medicine (Baltimore) 2022; 101:e30088. [PMID: 36042582 PMCID: PMC9410629 DOI: 10.1097/md.0000000000030088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
To explore the efficacy of low-frequency electric pulse therapy (LFEPT) combined with 2 antiemetics in the prevention and treatment of cisplatin-based chemotherapy-induced nausea and vomiting (CINV) in patients with lung adenocarcinoma. A total of 82 patients with lung adenocarcinoma who received cisplatin-based chemotherapy were randomly divided into the experimental group (n=41) and control group (n=41) by random numerical table method. The experimental group was treated with LFEPT combined with 2 antiemetic drugs (tropisetron hydrochloride and dexamethasone hydrochloride), while the control group was treated with the same 2 antiemetic drugs. Revised index of nausea and vomiting and retching (R-INVR) and Functional Living Index-Emesis (FLIE) scale were used to quantitatively evaluate the symptoms of nausea and vomiting after chemotherapy, and the effect of LFEPT in the prevention and treatment of CINV was observed. The baseline characteristics had no statistical difference between the 2 groups. The degree of nausea reaction, vomiting, and dry retching were similar in 2 groups on the first day after chemotherapy. However, the degree of nausea reaction, vomiting, and dry retching were significantly improved in the experimental group than that of the control group on 2 to 5 days with all P<.05. The score of FLIE had no difference between the 2 groups on the first day after chemotherapy (84.05 vs 82.69, P=.30), and the score was significantly higher in experiment group on day 6 compared with the control group (103.71 vs 89.38, P=.02). The side effects had no difference between the 2 groups. The LFEPT can significantly ameliorate CINV in patients with lung adenocarcinoma, which is worthy of clinical application.
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Affiliation(s)
- Ming Hu
- Department of Oncology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430014, China
| | - Lanhui Yao
- Department of Oncology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430014, China
| | - Li Li
- Department of Oncology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430014, China
- *Correspondence: Yonghong Han, Department of Oncology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430014, China (e-mail: )
| | - Yonghong Han
- Department of Oncology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430014, China
- *Correspondence: Yonghong Han, Department of Oncology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430014, China (e-mail: )
| | - Yuanyuan Wang
- Department of Oncology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430014, China
| | - Zhang Lei
- Department of Oncology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430014, China
| | - Hongbin Wu
- Department of Oncology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430014, China
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