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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Baa A, Pramanik R, Sharma A, Biswas A, JeeBharti S, Singh M, Kumar R, Gourishankar A, Jayant S, D'Souza A, Jadhav V, Khandare J. A feasibility study of EMF(erlotinib+methotrexate+5-fluorouracil) regimen in recurrent head and neck squamous cell carcinoma (HNSCC) and role of circulating tumour cells(CTCs) in assessment of outcomes. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.e18038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e18038 Background: Head and neck cancer is a huge burden in South East Asia with frequent relapse after curative therapy while the rest presenting in advanced unresectable stages. Financial constraints for targeted and immunotherapy make it inaccessible for the bulk of population. Thus, low-cost but efficacious regimen is highly implicated. We assessed if readily available triplet therapy of EMF, is superior in terms of extending life and maintaining quality of life along with evaluation of CTCs as a predictive biomarker in such patients. Methods: This was a single arm, phase II, investigator initiated interventional study, wherein 35 patients were enrolled. Platinum resistant/refractory patients of HNSCC were treated with combination of erlotinib 150mg daily, methotrexate 40 mg/m2 and 5-fluourouracil 500 mg/m2 (d1, d8) q28 days till progression or unacceptable toxicities. The primary endpoint was overall response rate(ORR) at 3 months; additional endpoints were disease control rate(DCR) at 3 months, overall survival (OS), progression free survival (PFS) safety and patient reported quality of life(QOL). The role of CTCs in gauging the responders and non-responders was monitored using anti Epithelial Cell Adhesion Molecule antibody based enrichment - OncoDiscover Drug Controller General of India (DCGI) approved platform. Results: The ORR and DCR at 3 months was 45.7% and 68.5%, respectively. The median PFS was 5 months (95%CI: 3.9-6 months) and median OS was 9 months (95%CI:7.4 -10.5 months). The 3 and 6 months PFS rates was 86 + 6% and 45 + 9%, respectively, while OS rates at 3 and 6 months were 91+ 5% and 68+ 8%, respectively. Rash, mucositis and fatigue were common adverse events occurring in 23 (65%), 14 (40%) and 9 (25.7%) respectively. The grade 3 events seen were rash in 5 (14.2%) and diarrhea in 2 (5.7%). Clinically significant improvement was seen in domains of role functioning, social functioning, fatigue, pain and global health status, swallowing, dryness of mouth and feeling ill. The mean CTC count at baseline was 0.90 + 1.1 /1.5ml of blood. Responders showed decline in levels from 1.19 + 0.25 to 0.33 + 0.48, while non-responders had increasing trend: 0.29 + 0.48 to 1+ 0.10 at 3 months (p = 0.010); with concordance rates with response being 52.9%. Additionally, CTC clearance at 3 months had numerically better PFS ̃ 6 months (95% CI: 4.72-7.72) and OS of 10 months (95% CI: 2.3-5.65) vs 4 months (95% CI: 2.3-5.65), p = 0.258 and 8 months (95% CI: 4.3-11.6), p = 0.203 in those with persistence of CTCs. Conclusions: The triplet regimen of EMF is a feasible, safe therapeutic option with favourable response rates and improved QOL in patients with platinum resistant/refractory HNSCC. CTCs have a promising futuristic role as a predictive biomarker and can be extrapolated in clinical upfront setting too. Clinical trial information: CTRI/2020/02/023378.
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Affiliation(s)
- Annie Baa
- All India Institute of Medical Science (AIIMS), New-delhi, India
| | - Raja Pramanik
- All India Institute of Medical Sciences, New Delhi, India
| | - Atul Sharma
- All India Institute of Medical Sciences, New Delhi, India
| | | | | | - Mayank Singh
- All India Institute of Medical Sciences, New Delhi, India
| | - Rajeev Kumar
- All India Institute of Medical Sciences, New Delhi, India
| | | | - Sreeja Jayant
- Actorius Innovations and Research Pvt. Ltd., Pune, India
| | - Alain D'Souza
- Actorius Innovations and Research Pvt. Ltd., Pune, India
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