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Yang LQ, Sun XC, Qin SK, Cheng Y, Shi JH, Chen ZD, Wang QM, Zhang HL, Hu B, Liu B, Zhang QY, Wu Q, Wang D, Shu YQ, Dong J, Han BH, Wang KM, Dang CX, Li JL, Wang HB, Li BL, Lu JG, Zhang ZH, Chen YX. Efficacy and safety of fosaprepitant in the prevention of nausea and vomiting following highly emetogenic chemotherapy in Chinese people: A randomized, double-blind, phase III study. Eur J Cancer Care (Engl) 2017; 26. [PMID: 28393417 PMCID: PMC5697660 DOI: 10.1111/ecc.12668] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2017] [Indexed: 11/30/2022]
Abstract
The prevention of chemotherapy‐induced nausea and vomiting was one of the most challenging supportive care issues in oncology, especially to highly emetogenic chemotherapy (HEC). A total of 645 patients were randomized into fosaprepitant group (fosaprepitant/placebo 150 mg d1 in combination with granisetron and dexamethasone) or aprepitant group (aprepitant/placebo 125 mg d1; 80 mg d2‐d3 plus granisetron and dexamethasone).The primary endpoint was the percentage of patients who had a complete response (CR) over the entire treatment course (0–120 hr, overall phase [OP]). It was assessed by using a non‐inferiority model, with a non‐inferiority margin of 10%. The difference of the CR rate was compared between two groups with chi‐square analysis. Six hundred and twenty‐six patients were included in the per protocol analysis. The percentage of patients with a CR in the fosaprepitant group was not inferior to that in the aprepitant group (90.85% versus 94.17%, p = .1302) during OP. Whether the cisplatin‐based chemotherapy or not, the CR rate of the fosaprepitant group was not inferior to that of the aprepitant group. Both regimens were well tolerated. The most common adverse event was constipation. Fosaprepitant provided effective and well‐tolerated control of nausea and vomiting associated with HEC in Chinese patients.
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Affiliation(s)
- L Q Yang
- Nanjing Medical University, Nanjing, China.,The Affiliated Bayi Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - X C Sun
- Nanjing Medical University, Nanjing, China.,The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - S K Qin
- The Affiliated Bayi Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Y Cheng
- Jilin Cancer Hospital, Changchun, China
| | - J H Shi
- Linyi Cancer Hospital, Linyi, China
| | - Z D Chen
- The Second Affiliated Hospital of Anhui Medical University, Anhui, China
| | - Q M Wang
- Henan Cancer Hospital, Zhengzhou, China
| | | | - B Hu
- Anhui Provincial Hospital, Hefei, China
| | - B Liu
- Shandong Cancer Hospital, Qingdao, China
| | - Q Y Zhang
- Harbin Medical University Cancer Hospital, Harbin, China
| | - Q Wu
- The First Affiliated Hospital of Bengbu Medical College, Bengbu, China
| | - D Wang
- The Third Affiliated Hospital of Third Military Medical University, Chongqing, China
| | - Y Q Shu
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - J Dong
- Yunnan Provincial Cancer Hospital, Kunming, China
| | - B H Han
- Shanghai Chest Hospital, Shanghai, China
| | - K M Wang
- The Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - C X Dang
- The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - J L Li
- Cancer Hospital Chinese Academy of Medical Sciences, Beijing, China
| | - H B Wang
- The Affiliated Hospital of Xuzhou Medical College, Xuzhou, China
| | - B L Li
- Beijing Chest Hospital of the Capital Medical College, Beijing, China
| | - J G Lu
- Nantong Tumor Hospital, Nantong, China
| | - Z H Zhang
- Sichuan Province Cancer Hospital, Chengdu, China
| | - Y X Chen
- The Affiliated Bayi Hospital of Nanjing University of Chinese Medicine, Nanjing, China
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Abstract
14065 Background: Primary liver cancer (PLC) is the 3rd most common cancer in whole China. Development of systemic chemotherapy for the patients not eligible for operation as well as TACE commonly have been required. Oxalipaltin (Eloxatin)+ 5-FU/LV, namely FOLFOX 4 regimen was tried to investigate its efficacy and safety in inoperable PLC. Methods: It was an open-label, single arm and multi-center phase II study to explore RR, DCR,TTP and MST. All the pts had pathologically confirmed inoperable PLC with/without distant metastasis. The pts were treated with the standard FOLFOX 4 regimen, that is OXA 85mg/m2 d1; LV 200mg/m2 IV 2hrs d1,2; 5-FU 400mg/m2 bolus, d1,2 and 5-FU 600mg/m2 CIV 22hrs d1,2; q2w upto 6 cycles or until progression. Tumor evaluation was done every 6 weeks using RECIST criteria. Neurotoxicity was evaluated by Eloxatin specific neurotoxicity criteria (Sanofi-Aventis Co.Ltd) and other toxicities by the NCI CTC AE version 2.0. Results: From July 2004 to Sep. 2005, 27 pts (21 male, 6 female) were recruited from the 4 cancer centers with average age of 56 ±13 years old. 25 patients (92.6%) had hepatocellular carcinoma, and 2 (7.4%) cholangiocellular carcinoma. 15 pts (55.6%) had metastatic disease. 1 pt received liver transplantation before inclusion. The median number of cycles was 4 per pt. 26 pts were evaluable for efficacy and safety. The RR was 19.2% (5/26; 1 CR and 4 PR), and DCR 57.7% (15/26; including 10 SD). 4 of the 5 responsive pts had hepatocellular carcinoma, and 1 had cholangiocarcinoma. Serum AFP level was significantly decreased (mean 131,890.4ug/dl at the baseline and 1,298.6ug/dl after 6 cycles) for the first 16 pts. The first 16 pts’ safety data were available in detail: 11 NCI grade 3/4 events were observed from a total of 76 cycles administered: including 5 neutropenia, 3 leucopenia, 1 thrombocytopenia, 1 infection and 1 liver dysfunction. Grade II & III neurotoxicity was found in 3 & 2 patients respectively. The TTP,MST and further safety data were under follow-up. Conclusions: The preliminary data of the FOLFOX 4 regimen for the advanced Chinese pts with inoperable PLC have shown encouraging results with the better efficacy and favorable safety profile. Further exploration in this area is warranted, especially in hepatocellular carcinoma. No significant financial relationships to disclose.
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Affiliation(s)
- S. K. Qin
- Chinese PLA Cancer Center, Nanjing, China
| | - Y. J. Wang
- Chinese PLA Cancer Center, Nanjing, China
| | - Q. Wu
- Chinese PLA Cancer Center, Nanjing, China
| | - B. C. Xing
- Chinese PLA Cancer Center, Nanjing, China
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