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Kanukollu S, Spatz K, Lavery JA, Bender JG, Mauguen A, Mathew S. Safety and tolerability of intravenous aprepitant and fosaprepitant in children with cancer: A retrospective, single-center review. Pediatr Blood Cancer 2024; 71:e30882. [PMID: 38267822 DOI: 10.1002/pbc.30882] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 12/14/2023] [Accepted: 01/10/2024] [Indexed: 01/26/2024]
Abstract
NK-1 receptor antagonists (NK1-RA) are key agents for chemotherapy-induced nausea and vomiting (CINV) prevention in patients receiving highly emetogenic chemotherapy. Current pediatric practice guidelines recommend the use of intravenous fosaprepitant or oral aprepitant. However, there are reports of hypersensitivity reactions with fosaprepitant due to polysorbate 80. Intravenous aprepitant does not contain polysorbate 80, but its use in pediatric patients has not been described. In this retrospective, single-center study, 106 pediatric patients received either fosaprepitant or intravenous aprepitant as part of their antiemetic regimen. Intravenous aprepitant was well tolerated and did not lead to any instances of hypersensitivity reactions requiring discontinuation.
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Affiliation(s)
- Srivarshini Kanukollu
- Department of Pharmacy, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Krisoula Spatz
- Department of Pharmacy, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Jessica A Lavery
- Department of Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Julia Glade Bender
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Audrey Mauguen
- Department of Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Sherry Mathew
- Department of Pharmacy, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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Inano H, Morimoto Y, Kitagawa K, Shibuya A, Nakagomi K, Ota T, Anzo Y, Miyauchi R, Shono A, Watanabe K, Otori K. Comparing the Efficacy of Fosnetupitant, an NK 1 Receptor Antagonist in CDDP-Based Regimens, with That of Fosaprepitant and Aprepitant: A Retrospective Observational Study. Biol Pharm Bull 2024; 47:692-697. [PMID: 38417893 DOI: 10.1248/bpb.b23-00819] [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] [Indexed: 03/01/2024]
Abstract
Existing antiemetic therapy against emetic-risk agents across malignancies 24 h post-dose in the acute period in cisplatin (CDDP)-based regimens yields a satisfactory complete response (CR) rate of ≥90%. However, the control rate after 24 h in the delayed period is unsatisfactory. This study compared the efficacy of fosnetupitant (F-NTP), a neurokinin 1 receptor antagonist, with that of fosaprepitant (F-APR) and aprepitant (APR) in the treatment of patients with cancer at high emetic risk due to chemotherapy. In this retrospective case-control study involving patients receiving cisplatin-containing regimens and neurokinin 1 receptor antagonists, patients were divided into three groups based on prophylactic antiemetic therapy: F-NTP, F-APR, and APR. The CR rate was evaluated for each period up to 168 h and further subdivided into acute (0-24 h), delayed (24-120 h), overall (0-120 h), and beyond-delayed (120-168 h) periods. Eighty-eight patients were included in the F-NTP group, 66 in the F-APR group, and 268 in the APR group. The CR rates at 0-168 and 120-168 h after cisplatin administration were significantly higher in the F-NTP group than in the F-APR and APR groups. After adjusting for confounding factors, F-NTP use was an independent factor in the multivariate analysis. Prophylactic antiemetic therapy, including F-NTP, was effective and well-tolerated during the delayed period. The efficacy of F-NTP in managing chemotherapy-induced nausea and vomiting was superior to those of F-APR and APR during the study period.
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Affiliation(s)
- Hiroshi Inano
- Department of Pharmacy, Kitasato University Hospital
| | - Yoshihito Morimoto
- Education and Research Center for Clinical Pharmacy, Showa Pharmaceutical University
| | | | - Akito Shibuya
- Department of Pharmacy, Kitasato University Hospital
| | | | - Tomohiro Ota
- Department of Pharmacy, Kitasato University Hospital
| | - Yuri Anzo
- Department of Pharmacy, Kitasato University Hospital
| | - Rika Miyauchi
- Education and Research Center for Clinical Pharmacy, Showa Pharmaceutical University
| | - Aiko Shono
- Laboratory of Social Pharmacy and Regulatory Science, Showa Pharmaceutical University
| | - Kazuhiro Watanabe
- Education and Research Center for Clinical Pharmacy, Showa Pharmaceutical University
| | - Katsuya Otori
- Department of Pharmacy, Kitasato University Hospital
- Laboratory of Pharmacy Practice and Science I, Research and Education Center for Clinical Pharmacy, School of Pharmacy, Kitasato University
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Perkovich B, Atayee RS, Kim JS, Rubenzik T. Use of Fosaprepitant for Management of Suspected Antimicrobial-Associated Nausea: A Case Report. J Pain Palliat Care Pharmacother 2024; 38:28-32. [PMID: 37983131 DOI: 10.1080/15360288.2023.2282465] [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: 09/06/2023] [Accepted: 11/05/2023] [Indexed: 11/22/2023]
Abstract
Intractable nausea can occur in numerous settings. We report on a 49-year-old woman with a past medical history of cystic fibrosis (CF) with chronic hypoxia, chronic nausea, complex infection history and frequent hospitalizations who was admitted to an academic medical center with a CF exacerbation. Her chronic nausea worsened with the use of antimicrobials, and she was unable to tolerate dopamine or serotonin antagonist antiemetics. Nausea persisted despite the use of benzodiazepines and antihistamines. She was given a one-time dose of fosaprepitant 150 mg intravenously (IV) with marked improvement of her nausea. During subsequent exacerbations, she again developed severe nausea which continued to respond well to a one-time dose of fosaprepitant 150 mg IV. Fosaprepitant is a substance P/neurokinin-1 (NK1) receptor antagonist that is FDA-approved for the prevention of chemotherapy-induced nausea and vomiting and has been used to prevent post-operative nausea and vomiting. Its use in other contexts has not been well established. This case suggests a role for fosaprepitant in the management of nausea outside the context of chemotherapy or general anesthesia.
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Affiliation(s)
- Brandon Perkovich
- Division of Geriatrics, Gerontology and Palliative Care, University of California San Diego, La Jolla, California, USA
| | - Rabia S Atayee
- Division of Geriatrics, Gerontology and Palliative Care, University of California San Diego, La Jolla, California, USA
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego, La Jolla, California, USA
- San Diego Health, Department of Pharmacy, University of California, San Diego, La Jolla, California, USA
| | - Jennifer S Kim
- Division of Geriatrics, Gerontology and Palliative Care, University of California San Diego, La Jolla, California, USA
| | - Tamara Rubenzik
- Division of Geriatrics, Gerontology and Palliative Care, University of California San Diego, La Jolla, California, USA
- Division of Nephrology and Hypertension, University of California San Diego, La Jolla, California, USA
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Yu LT, Wang Z, Han YL, Zhou F, Wagner LM, Zhang SG, Li ZL, Gao YJ. Comparison of oral aprepitant and intravenous fosaprepitant for prevention of chemotherapy-induced nausea and vomiting in pediatric oncology patients: a randomized phase III trial. Transl Pediatr 2024; 13:110-118. [PMID: 38323173 PMCID: PMC10839286 DOI: 10.21037/tp-23-598] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 01/05/2024] [Indexed: 02/08/2024] Open
Abstract
Background Neurokinin-1 receptor antagonists have improved the management of chemotherapy-induced nausea and vomiting (CINV), but to date there has been no prospective comparison between oral aprepitant and intravenous fosaprepitant in pediatric oncology patients. Methods Our study was a double-parallel study, and the distribution ratio was 1:1. Children aged 2-12 years who were undergoing moderate or highly emetogenic chemotherapy (MEC or HEC) were randomly assigned to receive ondansetron and dexamethasone combined with either a single dose of intravenous fosaprepitant (arm A), or 3 days of oral aprepitant (arm B). The primary outcome measure was the rate of complete response (CR) of CINV within the acute phase, defined as from the start through 24 hours after the last chemotherapy dose. Response during the delayed phase, overall response, and use of rescue antiemetics were also assessed. Results We prospectively evaluated 108 eligible patients, including 55 receiving fosaprepitant. Study observations were made during a single cycle for each patient. The occurrence of CR in the acute phase was statistically higher for patients receiving fosaprepitant (95% vs. 79%, P=0.018<0.05). Modest differences were seen in CR rates during the delayed phase (71% vs. 66%, P=0.586), and overall response rate (69% vs. 57%, P=0.179). The use of antiemetic rescue medicines was similar between arms A (11%) and B (7%). Conclusions Fosaprepitant produced more CRs of CINV in the acute phase than did aprepitant, although there were no statistical differences in delayed phase response, overall response, or use of rescue antiemetics. This study confirms the safety, efficacy, and potential advantages of fosaprepitant in reducing CINV in pediatric oncology patients. Trial Registration ClinicalTrials.gov identifier: NCT04873284.
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Affiliation(s)
- Li-Ting Yu
- Department of Pharmacy, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Zhuo Wang
- Department of Hematology/Oncology, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Ya-Li Han
- Department of Hematology/Oncology, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Fen Zhou
- Department of Hematology/Oncology, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Lars M. Wagner
- Division of Pediatric Hematology/Oncology, Duke University Medical Center, Durham, NC, USA
| | - Shun-Guo Zhang
- Department of Pharmacy, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Zhi-Ling Li
- Department of Pharmacy, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yi-Jin Gao
- Department of Hematology/Oncology, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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Xue F, Liu X, Qi X, Zhou J, Liu Y. The clinical research study for fosaprepitant to prevent chemotherapy-induced nausea and vomiting: A review. ADV CLIN EXP MED 2023. [PMID: 37026971 DOI: 10.17219/acem/157061] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 11/18/2022] [Accepted: 12/01/2022] [Indexed: 04/08/2023]
Abstract
In recent years, chemotherapy-induced nausea and vomiting (CINV) has become the most common adverse effect of chemotherapy in oncology patients. The CINV may reduce the quality of life in mild cases, or even make the patients resist or delay further treatment. Fosaprepitant is a newly marketed neurokinin-1 receptor antagonist (NK-1RA), which can be combined with 5-hydroxytryptamine 3 receptor antagonists (5-HT3RAs) and dexamethasone to prevent chemotherapy-induced vomiting. The dimeglumine salt form of fosaprepitant can be utilized as an intravenous injectable drug, which surpasses aprepitant's oral admistration limits. Fosaprepitant is effective and safe in the control of CINV in cancer patients receiving highly emetogenic chemotherapy (HEC), and may be an alternative option for antiemetic therapy. In general, fosaprepitant is worthy of clinical promotion and has a large market potential. This article reviews the clinical studies on fosaprepitant conducted in recent years, with the aim of providing a basis for the rational clinical selection of antiemetic drugs.
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Affiliation(s)
- Fei Xue
- Traditional Chinese Medicine General Practice Department, Yantai Hospital of Traditional Chinese Medicine, China
| | - Xin Liu
- Research and Development Department, Shandong Xianglong Pharmaceutical Research Institute Co., Ltd, Yantai, China
| | - Xiao Qi
- Respiratory Department, Yantai Hospital of Traditional Chinese Medicine, China
| | - Jiajing Zhou
- Oncology Department, Yantai Hospital of Traditional Chinese Medicine, China
| | - Yongjun Liu
- Department of Traditional Chinese Medicine, Shandong Drug and Food Vocational College, Weihai, China
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Zhao Y, Zhao B, Chen G, Chen Y, Liao Z, Zhang H, Feng W, Li Y, Weng H, Li W, Zhou Y, Ren B, Lu Y, Chen J, Liu Z, Su Z, Wang W, Zhang L. Validation of different personalized risk models of chemotherapy-induced nausea and vomiting: results of a randomized, double-blind, phase III trial of fosaprepitant for cancer patients treated with high-dose cisplatin. Cancer Commun (Lond) 2022; 43:246-256. [PMID: 36545810 PMCID: PMC9926955 DOI: 10.1002/cac2.12397] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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] [Received: 04/23/2022] [Revised: 11/18/2022] [Accepted: 12/09/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Highly emetogenic chemotherapy induces emesis in cancer patients without prophylaxis. The purpose of this study was to evaluate the efficacy and safety of a fosaprepitant-based triple antiemetic regimen for the prevention of chemotherapy-induced nausea and vomiting (CINV) in patients with solid malignant tumors, determine risk factors and externally validate different personalized risk models for CINV. METHODS This phase III trial was designed to test the non-inferiority of fosaprepitant toward aprepitant in cancer patients who were to receive the first cycle of single-day cisplatin chemotherapy. The primary endpoint was complete response (CR) during the overall phase (OP) with a non-inferiority margin of 10.0%. Logistic regression models were used to assess the risk factors of CR and no nausea. To validate the personalized risk models, the accuracy of the risk scoring systems was determined by measuring the specificity, sensitivity and area under the receiver operating characteristic (ROC) curve (AUC), while the predictive accuracy of the nomogram was measured using concordance index (C-index). RESULTS A total of 720 patients were randomly assigned. CR during the OP in the fosaprepitant group was not inferior to that in the aprepitant group (78.1% vs. 77.7%, P = 0.765) with a between-group difference of 0.4% (95% CI, -5.7% to 6.6%). Female sex, higher cisplatin dose (≥ 70 mg/m2 ), no history of drinking and larger body surface area (BSA) were significantly associated with nausea. The AUC for the acute and delayed CINV risk indexes was 0.68 (95% CI: 0.66-0.71) and 0.66 (95% CI: 0.61-0.70), respectively, and the C-index for nomogram CINV prediction was 0.59 (95% CI, 0.54-0.64). Using appropriate cutoff points, the three models could stratify patients with high- or low-risk CINV. No nausea and CR rate were significantly higher in the low-risk group than in the high-risk group (P < 0.001). CONCLUSIONS Fosaprepitant-based triple prophylaxis demonstrated non-inferior control for preventing CINV in patients treated with cisplatin-base chemotherapy. Female cancer patients without a history of alcohol consumption, with larger BSA and received high-dose cisplatin might be more vulnerable to CINV. Three personalized prediction models were well-validated and could be used to optimize antiemetic therapy for individual patients.
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Affiliation(s)
- Yuanyuan Zhao
- Department of Medical OncologySun Yat‐sen University Cancer CenterState Key Laboratory of Oncology in South ChinaCollaborative Innovation Center for Cancer MedicineGuangzhouGuangdongP. R. China
| | - Bing Zhao
- Department of Day WardFirst Affiliated Hospital of Xinjiang Medical UniversityUrumqiXinjiangP. R. China
| | - Gang Chen
- Department of Medical OncologySun Yat‐sen University Cancer CenterState Key Laboratory of Oncology in South ChinaCollaborative Innovation Center for Cancer MedicineGuangzhouGuangdongP. R. China
| | - Yinlan Chen
- Department of Medical OncologyJiangxi Cancer HospitalNanchangJiangxiP. R. China
| | - Zijun Liao
- Department of Medical OncologyShaanxi Provincial Cancer HospitalXi'anShaanxiP. R. China
| | - Haiming Zhang
- Department of Medical OncologyThe First People Hospital of XiangtanXiangtanHunanP. R. China
| | - Weineng Feng
- Department of Medical OncologyThe First People Hospital of FoshanFoshanGuangdongP. R. China
| | - Yinyin Li
- Department of Medical OncologyShenyang Tenth People's HospitalShenyangLiaoningP. R. China
| | - Heng Weng
- Respiratory MedicineFuzhou Pulmonary Hospital of FujianFuzhouFujianP. R. China
| | - Weidong Li
- Department of Medical OncologyAffiliated Cancer Hospital & Institute of Guangzhou Medical UniversityGuangzhouGuangdongP. R. China
| | - Yuefen Zhou
- Department of Medical OncologyThe Central Hospital of LishuiLishuiZhejiangP. R. China
| | - Biyong Ren
- Department of Medical OncologyChongqing Three Gorges Central HospitalChongqingP. R. China
| | - Yanda Lu
- Department of Medical OncologyThe First Affiliated Hospital of Hainan Medical UniversityHaikouHainanP. R. China
| | - Jianhua Chen
- Department of Medical OncologyHunan Province Tumor HospitalChangshaHunanP. R. China
| | - Zhenteng Liu
- Institute of Materia MedicaLuoxin Pharmaceutical Group Co., LtdShanghaiP. R. China
| | - Zhenzhong Su
- Institute of Materia MedicaLuoxin Pharmaceutical Group Co., LtdShanghaiP. R. China
| | - Wenliang Wang
- Institute of Materia MedicaLuoxin Pharmaceutical Group Co., LtdShanghaiP. R. China
| | - Li Zhang
- Department of Medical OncologySun Yat‐sen University Cancer CenterState Key Laboratory of Oncology in South ChinaCollaborative Innovation Center for Cancer MedicineGuangzhouGuangdongP. R. China
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Braga ELC, Verçosa N, Cavalcanti IL. Comparative Study Between Fosaprepitant and Palonosetron in the Prophylaxis of Postoperative Nausea and Vomiting in Women Undergoing Laparoscopic Cholecystectomy: Prospective, Randomized and Double-Blind Study. Front Pharmacol 2022; 13:915347. [PMID: 35645797 PMCID: PMC9130472 DOI: 10.3389/fphar.2022.915347] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 04/20/2022] [Indexed: 11/25/2022] Open
Abstract
Objective: To test the hypothesis that the single use of fosaprepitant is not inferior to the use of palonosetron as antiemetic prophylaxis in the first 48 h after surgery in women undergoing laparoscopic cholecystectomy. Method: Eighty-eight nonsmoking women (American Society of Anesthesiologists physical status I or II) aged between 18 and 60 years who underwent laparoscopic cholecystectomy received 150 mg of fosaprepitant or 75 μg of palonosetron, administered intravenously after the induction of general anesthesia. Results: In the fosaprepitant group and in the palonosetron group, 13.6 and 18.2% of the patients, respectively, vomited in the first 48 h after surgery (p = 0.560). There were no differences between groups in the total frequency and intensity of nausea, number of complete responders, need for rescue medication, time required for the first rescue medication dose or number of adverse events. Conclusion: The administration of a single dose of fosaprepitant after the induction of anesthesia was as effective as the administration of a single dose of palonosetron for the prophylaxis of vomiting in the first 48 h after surgery in women undergoing laparoscopic cholecystectomy.
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Affiliation(s)
- Estêvão Luiz Carvalho Braga
- Department of General and Specialized Surgery, Medical Sciences Postgraduate Program, Fluminense Federal University, Niterói, Brazil
| | - Nubia Verçosa
- Department of Surgery/Anaesthesiology, Surgical Sciences Postgraduate Program, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Ismar Lima Cavalcanti
- Department of General and Specialized Surgery, Medical Sciences Postgraduate Program, Fluminense Federal University, Niterói, Brazil
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Matsuura K, Tsurutani J, Inoue K, Tanabe Y, Taira T, Kubota K, Tamura T, Saeki T. A phase 3 safety study of fosnetupitant as an antiemetic in patients receiving anthracycline and cyclophosphamide: CONSOLE-BC. Cancer 2022; 128:1692-1698. [PMID: 35045185 PMCID: PMC9306508 DOI: 10.1002/cncr.34088] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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] [Received: 10/21/2021] [Revised: 12/10/2021] [Accepted: 12/13/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Fosnetupitant (FosNTP), an intravenous neurokinin 1 receptor antagonist, demonstrated a favorable safety profile with a potentially low risk of injection site reactions (ISRs) and promising antiemetic efficacy in patients receiving cisplatin‐based highly emetogenic chemotherapy in a previous phase 2 study. We conducted a randomized, double‐blind safety study to evaluate the safety profile of FosNTP, including ISRs, in patients receiving doxorubicin‐cyclophosphamide or epirubicin‐cyclophosphamide (AC/EC) chemotherapy. METHODS Patients scheduled to receive AC/EC were randomized 1:1 to receive 235 mg of FosNTP or 150 mg of fosaprepitant (FosAPR), both in combination with 0.75 mg of intravenous palonosetron and 9.9 mg of dexamethasone on day 1. The stratification factors were age category (<55 vs ≥55 years) and study site. The primary end point was the incidence of treatment‐related adverse events (TRAEs) with FosNTP. RESULTS Overall, 102 patients were randomized to FosNTP (n = 52) or FosAPR (n = 50), and all were treated with the study drug and evaluated for safety. The primary end point, the incidence of TRAEs, was similar with FosNTP (21.2%; 95% confidence interval [CI], 11.1%‐34.7%) and FosAPR (22.0%; 95% CI, 11.5%‐36.0%), with any‐cause ISRs observed in 5.8% and 26.0% of patients, respectively, and treatment‐related ISRs observed in 0% and 10.0%, respectively. The overall (0‐120 hour) complete response (defined as no emetic event and no rescue medication) rate, standardized by age category in the full analysis set, was 45.9% (23 of 51 patients) with FosNTP and 51.3% (25 of 49 patients) with FosAPR. CONCLUSIONS FosNTP demonstrated a favorable safety profile with a very low risk of ISRs in the AC/EC setting. Fosnetupitant shows a favorable safety profile in patients receiving doxorubicin‐cyclophosphamide or epirubicin‐cyclophosphamide chemotherapy. As an intravenous neurokinin 1 receptor antagonist with a low risk of causing injection site reactions, fosnetupitant may be used for protecting patients with cancer from experiencing chemotherapy‐induced nausea and vomiting.
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Affiliation(s)
- Kazuo Matsuura
- Department of Breast Oncology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Junji Tsurutani
- Advanced Cancer Translational Research Institute, Showa University, Tokyo, Japan
| | - Kenichi Inoue
- Department of Breast Oncology, Saitama Cancer Center, Saitama, Japan
| | - Yuko Tanabe
- Department of Medical Oncology, Toranomon Hospital, Tokyo, Japan
| | - Tetsuhiko Taira
- Department of Medical Oncology, Sagara Hospital, Kagoshima, Japan
| | - Kaoru Kubota
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Tomohide Tamura
- Thoracic Center, St. Luke's International Hospital, Tokyo, Japan
| | - Toshiaki Saeki
- Department of Breast Oncology, Saitama Medical University International Medical Center, Saitama, Japan
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Shimamoto F, Goto M, Terazawa T, Asaishi K, Miyamoto T, Higuchi K. Pharmacokinetics of Dexamethasone when Administered with Fosaprepitant for Chemotherapy-Induced Nausea and Vomiting and Differences in Dose-Dependent Antiemetic Effects. Asian Pac J Cancer Prev 2021; 22:871-877. [PMID: 33773552 PMCID: PMC8286666 DOI: 10.31557/apjcp.2021.22.3.871] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Fosaprepitant, an NK1 receptor antagonist, inhibits and induces cytochrome P450 3A4 (CYP3A4) as its substrate. Contrarily dexamethasone is metabolized by CYP3A4. Therefore, in combination therapy wherein both agents interact with each other, it is recommended that the dexamethasone dose be reduced in the first two days. Thus far, there are only a few studies on the optimum dose of dexamethasone after day 3. Thus, we aimed to determine the pharmacokinetics of dexamethasone on day3 when administered together with fosaprepitant and investigate the dose-dependent differences in its antiemetic effect in patients with cancer. METHODS Twelve patients with esophageal, stomach, or lung cancer received primary highly emetogenic chemotherapy (HEC). We intravenously administered 9.9 mg and 6.6 mg of dexamethasone on days 1 and 2, respectively, and 6.6 mg or 13.2 mg on day 3 together with the administration of 150 mg fosaprepitant and 0.75 mg palonosetron. We assessed the pharmacokinetics of dexamethasone on day 3 by dose and examined the dose-dependent antiemetic effect. RESULTS No differences were observed in the time-to-maximum concentration and blood half-life of dexamethasone between patient groups that received dexamethasone at doses of 6.6 mg and 13.2 mg. In contrast, the area under the blood concentration-time curve and the maximum concentration of dexamethasone correlated with its dose. Moreover, the blood dexamethasone concentration on day 3 increased by twofold after the administration of a higher dose than after a lower dose. The severity of nausea in the delayed phase significantly decreased in a dose-dependent manner. CONCLUSION Administration of a higher dexamethasone dose on day 3 improved the antiemetic effect of the combined regimen in patients with cancer who underwent HEC.<br />.
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Affiliation(s)
- Fukutaro Shimamoto
- Cancer Chemotherapy Center, Osaka Medical College Hospital, 2-7, Daigaku-machi, Takatsuki, Osaka 569-8686, Japan
| | - Masahiro Goto
- Cancer Chemotherapy Center, Osaka Medical College Hospital, 2-7, Daigaku-machi, Takatsuki, Osaka 569-8686, Japan
| | - Tetsuji Terazawa
- Cancer Chemotherapy Center, Osaka Medical College Hospital, 2-7, Daigaku-machi, Takatsuki, Osaka 569-8686, Japan
| | - Ken Asaishi
- Cancer Chemotherapy Center, Osaka Medical College Hospital, 2-7, Daigaku-machi, Takatsuki, Osaka 569-8686, Japan
| | - Takahiro Miyamoto
- Cancer Chemotherapy Center, Osaka Medical College Hospital, 2-7, Daigaku-machi, Takatsuki, Osaka 569-8686, Japan
| | - Kazuhide Higuchi
- Second Department of Internal Medicine, Osaka Medical College, 2-7, Daigaku-machi, Takatsuki, Osaka 569-8686, Japan
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10
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Lu K, Lin S, Wang Y, Hao R, Fang L, Zhu J, Zhao D, Yu J, Tong S, Wu Y, Si Y, Ye T, Yang Q, Wang Y. Pharmacokinetics and Safety of Fosaprepitant Dimeglumine in Healthy Chinese Volunteers: Bioequivalence Study. Clin Pharmacol Drug Dev 2020; 10:748-755. [PMID: 33277980 DOI: 10.1002/cpdd.892] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 11/09/2020] [Indexed: 11/12/2022]
Abstract
Fosaprepitant dimeglumine (FD) is a precursor of aprepitant. FD can be metabolized into aprepitant. This randomized, single-center, open, 2-cycle, single-dose, crossover bioequivalence study compared the pharmacokinetics (PK) and safety of intravenously FD of test and reference products in healthy volunteers (HVs). HVs were assigned to the test group or reference group randomly and given FD intravenously. The plasma concentration of FD and aprepitant was measured using liquid chromatography-tandem mass spectrometry. PK parameters were ascertained based on a noncompartmental model. Data for 29 HVs were obtained. The geometric mean and 90% confidence intervals of maximum plasma concentration (Cmax ), area under the concentration-time curve from time 0 to time of last measurable plasma concentration (AUC0-t ), and area from the last datum point to time infinity (AUC0-∞ ) of test and reference groups were 101.69% (95.06%, 108.77%), 103.52% (99.15%, 108.09%), and 105.58% (99.51%, 112.01%), respectively. These 3 parameters were within the acceptance range of 80.0% to 125.00%, and the test product was bioequivalent to the reference product. The coefficient of variation (CV) of Cmax , AUC0-t , and AUC0-∞ was 15.14%, 9.67%, and 11.89%, respectively. Intravenously administered FD provided by 2 sponsors achieved bioequivalence. FD values from test and reference products were bioequivalent. All adverse events were mild and serious adverse events absent in HVs. This study indicated that FD may provide a safer alternative to aprepitant for chemotherapy-induced nausea and vomiting.
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Affiliation(s)
- Kang Lu
- Bengbu Medical College, Bengbu, China
| | - Sisi Lin
- Phase I Clinical Research Center, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Yannan Wang
- Phase I Clinical Research Center, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Rui Hao
- Phase I Clinical Research Center, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Lu Fang
- Phase I Clinical Research Center, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Jingjing Zhu
- Phase I Clinical Research Center, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Di Zhao
- Phase I Clinical Research Center, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Jin Yu
- Phase I Clinical Research Center, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Shengjia Tong
- Phase I Clinical Research Center, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Yi Wu
- Phase I Clinical Research Center, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Yongkai Si
- Phase I Clinical Research Center, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Tiantian Ye
- Phase I Clinical Research Center, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Qigang Yang
- Phase I Clinical Research Center, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Ying Wang
- Phase I Clinical Research Center, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China.,Clinical Research Institute, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
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11
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Segna AN, Baron RH, Cohen B. Infusion Site Reactions: Classification in the Setting of Fosaprepitant Administration With Chemotherapy. Clin J Oncol Nurs 2020; 24:E79-E84. [PMID: 33216065 DOI: 10.1188/20.cjon.e79-e84] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Studies report a wide range of incidence and severity of infusion site adverse events (ISAEs) following fosaprepitant administration. OBJECTIVES The purposes of this study were (a) to determine the incidence of suspected extravasation in patients with cancer receiving fosaprepitant infusions with chemotherapy and (b) to determine whether the documented signs, symptoms, and management strategies aligned with the diagnostic criteria for extravasation versus non-extravasation ISAEs. METHODS Electronic health records were used to identify patients who received fosaprepitant infusion with chemotherapy and had documentation for suspected extravasation. Chart reviews were conducted for a sample of patients to determine whether documentation was consistent with extravasation. FINDINGS About 3% (n = 460 of 15,667) of patients who received fosaprepitant had documentation for suspected extravasation. Among a random sample of patients (N = 110) with suspected extravasation, 6% (n = 6) had documentation consistent with extravasation.
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12
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Abstract
INTRODUCTION The incidence of Ifosfamide-induced encephalopathy (IIE) ranges from 5-30%. Aprepitant and fosaprepitant may increase the risk of IIE; however, data is limited. The objective of this study was to characterize the incidence of IIE in patients receiving concomitant fosaprepitant. METHODS This single-center, retrospective chart review included adult patients diagnosed with sarcoma who received at least one administration of high dose ifosfamide (≥1800mg/m2) and fosaprepitant between January 2017 and June 2018. The primary endpoint was the percentage of patient cycles in which IIE was experienced. Secondary endpoints included characterization of IIE management strategies, time to IIE resolution, and the incidence of IIE upon ifosfamide re-challenge. Subgroup analyses were performed to assess whether the following variables predisposed a patient to neurotoxicity: elevated serum creatinine, hypoalbuminemia, metabolic acidosis, hyperbilirubinemia, shorter infusion time, and higher body mass index. The role of CYP2B6 inhibitors and prior cisplatin use were also examined. RESULTS Fifty-one patients who received 215 total cycles of ifosfamide were included. Twenty (9.3%) patient cycles included documented evidence of IIE. The most common management strategies were to prolong the infusion time and administer methylene blue. The mean time to resolution of IIE was 2.58 days. The incidence of secondary IIE upon re-challenge was 26.3%. Baseline albumin <3.5 g/dL (p<0.001) was statistically associated with the development of IIE. CONCLUSION Co-administration of fosaprepitant and ifosfamide in sarcoma appears to be safe. Hypoalbuminemia was a notable risk factor confirmed in this study. Further research is needed to delineate IIE risk factors.
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Affiliation(s)
- Jill N Modi
- NYC Health and Hospitals/Queens, Jamaica, NY, USA
| | - Sarah K Cimino
- Vanderbilt University Medical Center, Nashville, TN, USA
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13
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Cabanillas Stanchi KM, Willier S, Vek J, Schlegel P, Queudeville M, Rieflin N, Klaus V, Gansel M, Rupprecht JV, Flaadt T, Binder V, Feuchtinger T, Lang P, Handgretinger R, Döring M. Antiemetic Prophylaxis with Fosaprepitant and 5-HT 3-Receptor Antagonists in Pediatric Patients Undergoing Autologous Hematopoietic Stem Cell Transplantation. Drug Des Devel Ther 2020; 14:3915-3927. [PMID: 33061297 PMCID: PMC7524181 DOI: 10.2147/dddt.s260887] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 08/21/2020] [Indexed: 02/03/2023]
Abstract
Background High-dose myeloablative conditioning prior to autologous hematopoietic stem cell transplantation (autoHSCT) in pediatric patients is usually highly emetogenic. The antiemetic neurokinin-1 receptor antagonist fosaprepitant was safe and effective in children receiving highly emetogenic chemotherapy. Data on fosaprepitant during autoHSCT in children are currently not available. Methods A total of 35 consecutive pediatric patients, who received an antiemetic prophylaxis with fosaprepitant (4 mg/kg; single dose, max. 1 x 150 mg/kg BW) and ondansetron (24-hours continuous infusion; 8–32 mg/24h) or granisetron (2 x 40 µg/kg∙d−1) during highly emetogenic conditioning chemotherapy before autoHSCT were retrospectively analyzed, and their results were compared with a control group comprising 35 consecutive pediatric patients, who received granisetron or ondansetron only. The antiemetic efficacy and the safety of the two prophylaxis regimens were compared with respect to three time periods after the first chemotherapy administration (0–24h, >24–120h, >120–240h). Results Clinical adverse events and clinically relevant increases/decreases of laboratory markers were similarly low and did not significantly differ between the two study groups (p>0.05). The registered number of vomiting events was significantly higher in the control group in the time periods of 0–24h (64 vs 22 events; p<0.01), >24–120h (135 vs 78 events; p<0.0001), >120–240h (268 vs 105 events; p<0.0001), and the whole observation period 0–240h (467 vs 205 events; p<0.0001). The percentage of patients experiencing vomiting was higher in the control group during the time period of >24–120h (100% vs 74.3%) but not the other analyzed time periods (p>0.05). Conclusion The fosaprepitant-based antiemetic prophylaxis was safe, well tolerated and significantly reduced vomiting in children undergoing highly emetogenic chemotherapy prior to autoHSCT. Prospective randomized trials are necessary to confirm these results.
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Affiliation(s)
| | - Semjon Willier
- Department of Pediatric Hematology, Oncology, Hemostaseology and Stem Cell Transplantation, Dr. Von Hauner Children's Hospital, University Hospital, LMU, Munich, Germany
| | - Julia Vek
- Department of General Pediatrics, Hematology/Oncology, University Children's Hospital Tübingen, Tübingen, Germany
| | - Patrick Schlegel
- Department of General Pediatrics, Hematology/Oncology, University Children's Hospital Tübingen, Tübingen, Germany
| | - Manon Queudeville
- Department of General Pediatrics, Hematology/Oncology, University Children's Hospital Tübingen, Tübingen, Germany
| | - Nora Rieflin
- Department of General Pediatrics, Hematology/Oncology, University Children's Hospital Tübingen, Tübingen, Germany
| | - Veronika Klaus
- Department of General Pediatrics, Hematology/Oncology, University Children's Hospital Tübingen, Tübingen, Germany
| | - Melanie Gansel
- Department of General Pediatrics, Hematology/Oncology, University Children's Hospital Tübingen, Tübingen, Germany
| | - Joachim Vincent Rupprecht
- Department of General Pediatrics, Hematology/Oncology, University Children's Hospital Tübingen, Tübingen, Germany
| | - Tim Flaadt
- Department of General Pediatrics, Hematology/Oncology, University Children's Hospital Tübingen, Tübingen, Germany
| | - Vera Binder
- Department of Pediatric Hematology, Oncology, Hemostaseology and Stem Cell Transplantation, Dr. Von Hauner Children's Hospital, University Hospital, LMU, Munich, Germany
| | - Tobias Feuchtinger
- Department of Pediatric Hematology, Oncology, Hemostaseology and Stem Cell Transplantation, Dr. Von Hauner Children's Hospital, University Hospital, LMU, Munich, Germany
| | - Peter Lang
- Department of General Pediatrics, Hematology/Oncology, University Children's Hospital Tübingen, Tübingen, Germany
| | - Rupert Handgretinger
- Department of General Pediatrics, Hematology/Oncology, University Children's Hospital Tübingen, Tübingen, Germany
| | - Michaela Döring
- Department of General Pediatrics, Hematology/Oncology, University Children's Hospital Tübingen, Tübingen, Germany
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14
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Zhang Z, Yang Y, Lu P, Li X, Chang J, Zheng R, Zhou L, Chen S, Chen X, Ren B, Gu W, Jiang X, Peng J, Huang M, Feng G, Shen P, Zhang Q, Zhang B, Huang Y, He J, Chen Y, Cao J, Wang H, Li W, Wan H, Nan K, Liao Z, Zhang C, Lin Z, Zhong D, Xu Q, Liu H, Sun T, Deng Y, Zhang L. Fosaprepitant versus aprepitant in the prevention of chemotherapy-induced nausea and vomiting in patients receiving cisplatin-based chemotherapy: a multicenter, randomized, double-blind, double-simulated, positive-controlled phase III trial. Ann Transl Med 2020; 8:234. [PMID: 32309381 PMCID: PMC7154406 DOI: 10.21037/atm.2019.12.158] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background To establish the role of antiemetic therapy with neurokinin-1 (NK-1) receptor antagonists (RAs) in Chinese patients associated with cisplatin-base chemotherapy regimens, this study evaluated the efficacy and safety of single-dose intravenous fosaprepitant-based triple antiemetic regimen to a 3-day orally aprepitant-based antiemetic triplet schedule for the prevention of chemotherapy-induced nausea and vomiting (CINV). Methods A randomized, double-blind, positive-control design was used to test the noninferiority of fosaprepitant towards aprepitant. Patients receiving cisplatin-base (≥50 mg/m2) chemotherapy were administrated palonosetron and dexamethasone with a single-dose fosaprepitant (150 mg on day 1) or a standard aprepitant regimen (125 mg on day 1, 80 mg on day 2 and day 3). The primary endpoint was complete response (CR) during overall phase (OP). Secondary endpoints include CR during acute phase (AP) and delayed phase (DP), no vomiting and no significant nausea during OP, AP and DP. Accrual of 324 patients per treatment arm was planned to confirm noninferiority with expected CR of 75% and noninferiority margin of minus 10 percentage points. Results A total of 648 patients were randomly assigned, and 644 were evaluable for efficacy and safety. Antiemetic efficacy of CR during the OP with fosaprepitant and aprepitant was equivalent (71.96% versus 69.35%, P=0.4894). And a between-group difference of 2.61 percentage points was finally achieved (95% CI, -4.42 to 9.64) within predefined bounds for noninferiority (primary end point achieved). Both regimens were well tolerated and commonly reported adverse events (≥1%) were similar between these two group. Conclusions Single-dose intravenous fosaprepitant (150 mg) combined with palonosetron and dexamethasone was well tolerated and demonstrated noninferior control of CINV to aprepitant-based triple regimen in Chinese patients treating with cisplatin-base chemotherapy.
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Affiliation(s)
- Zhonghan Zhang
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
| | - Yunpeng Yang
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
| | - Ping Lu
- Oncology Internal Medicine, the First Affiliated Hospital of Xinxiang Medical College, Xinxiang 453000, China
| | - Xiaoqin Li
- Oncology Department, Jiangsu University Affiliated Hospital, Zhenjiang 212031, China
| | - Jianhua Chang
- Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai 200000, China
| | - Rongsheng Zheng
- Oncology Internal Medicine, the First Affiliated Hospital of Bengbu Medical College, Bengbu 233000, China
| | - Lei Zhou
- Oncology Department, Beijing Century Temple Hospital, Beijing 100000, China
| | - Shaoshui Chen
- Oncology Department, Binzhou Medical University Hospital, Binzhou 256602, China
| | - Xiaopin Chen
- Department of Medical Oncology, the First Affiliated Hospital of Chongqing Medical University, Chongqing 400000, China
| | - Biyong Ren
- Department of Oncology, Chongqing Three Gorges Central Hospital, Chongqing 400000, China
| | - Wei Gu
- Department of Respiratory Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing 210029, China
| | - Xiaodong Jiang
- Department of Oncology, the First People's Hospital of Lianyungang, Lianyungang 222002, China
| | - Jiyong Peng
- Oncology Department, Jiangxi Pingxiang People's Hospital, Pingxiang 337055, China
| | - Miaolong Huang
- Department of Thoracic Surgery, People's Hospital of Northern Guangdong, Shaoguan 512000, China
| | - Guosheng Feng
- Department of Chemotherapy, the People's Hospital of Guangxi Zhuang Autonomous Region, Nanning 530000, China
| | - Peng Shen
- Chemotherapy Ward, the First Affiliated Hospital of Zhejiang University, Hangzhou 310000, China
| | - Qingyuan Zhang
- First Ward of Internal Medicine of Mammary Gland, Harbin Medical University Cancer Hospital, Harbin 150000, China
| | - Baihong Zhang
- Department of Oncology, the 940th Hospital of Joint Logistics Support Force of People's Liberation Army, Lanzhou 730030, China
| | - Yan Huang
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
| | - Jingdong He
- Department of Medical Oncology, Huai'an First People's Hospital, Huai'an 223001, China
| | - Yinglan Chen
- Thoracic Neoplasms, Jiangxi Provincial Cancer Hospital, Nanchang 330000, China
| | - Jingxu Cao
- Oncology Department, Hospital of Armed Police Force, Beijing 100000, China
| | - Hong Wang
- Oncology Department, the Third Hospital of Nanchang City, Nanchang 330000, China
| | - Wei Li
- Department of Medical Oncology, the First Bethune Hospital of Jilin University, Changchun 130000, China
| | - Huiping Wan
- Oncology Department, Jiangxi Provincial People's Hospital, Nanchang 330000, China
| | - Kejun Nan
- Department of Medical Oncology, Xi'an Jiaotong University the First Hospital, Xi'an 710000, China
| | - Zijun Liao
- Department of Medical Oncology, Shaanxi Provincial Tumor Hospital, Xi'an 710000, China
| | - Cuiying Zhang
- Oncology Internal Medicine, Inner Mongolia People's Hospital, Huhehaote 010000, China
| | - Zhong Lin
- Oncology Center, the Fifth Affiliated Hospital Sun Yat-sen University, Zhuhai 519000, China
| | - Diansheng Zhong
- The Medical Department, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Qing Xu
- Department of Oncology, Shanghai Tenth People's Hospital of Tongji University, Shanghai 200000, China
| | - Hailong Liu
- Oncology, Chenzhou No. 1 People's Hospital, Chenzhou 423099, China
| | - Tao Sun
- Galactophore Clinic, Liaoning Cancer Hospital and Institute, Shenyang 110000, China
| | - Yanming Deng
- Department of Cancer Center, Foshan First People's Hospital, Foshan 528000, China
| | - Li Zhang
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
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15
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Matsumoto K, Takahashi M, Sato K, Osaki A, Takano T, Naito Y, Matsuura K, Aogi K, Fujiwara K, Tamura K, Baba M, Tokunaga S, Hirano G, Imoto S, Miyazaki C, Yanagihara K, Imamura CK, Chiba Y, Saeki T. A double-blind, randomized, multicenter phase 3 study of palonosetron vs granisetron combined with dexamethasone and fosaprepitant to prevent chemotherapy-induced nausea and vomiting in patients with breast cancer receiving anthracycline and cyclophosphamide. Cancer Med 2020; 9:3319-3327. [PMID: 32168551 PMCID: PMC7221309 DOI: 10.1002/cam4.2979] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [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] [Received: 07/08/2019] [Revised: 01/31/2020] [Accepted: 02/04/2020] [Indexed: 11/07/2022] Open
Abstract
Purpose To investigate whether palonosetron is better than granisetron in preventing chemotherapy‐induced nausea and vomiting (CINV) in a three‐drug combination with dexamethasone and fosaprepitant (Fos) in patients with breast cancer who are placed on anthracycline and cyclophosphamide (AC‐based regimen). Patients and Methods Chemo‐naive women with primary breast cancer were randomly administered either palonosetron 0.75 mg (day 1) or granisetron 1 mg (day 1) combined with dexamethasone (12 mg at day 1, 8 mg at day 2 and day 3) and Fos 150 mg (day 1) before receiving AC‐based regimen in a double‐blind study. The primary endpoint was the complete response (CR) rate of emesis in cycle 1 in the delayed phase. This was defined as neither vomiting nor rescue drug usage for emesis at >24‐120 hours after chemotherapy. Secondary endpoints were the CR in the acute/overall phase (0‐24/0‐120 hours, respectively, after chemotherapy), no nausea and vomiting, Patient‐Reported Outcomes version of the Common Terminology Criteria for Adverse Events (PRO‐CTCAE), and safety. Results From December 2012 to October 2014, 326 patients were treated and evaluated (164/162 evaluable patients in granisetron/palonosetron arm, respectively). The CR during the delayed phase was 60.4% in the granisetron regimen and 62.3% in the palonosetron regimen. The CR during acute phase (73.2% vs 75.9%, respectively) and the CR during overall phase (54.9% in both regimens) were very identical. A significantly higher number of patients in the palonosetron arm were free from nausea during the delayed phase (28% vs 40.1%; P = .029). Adverse events were also identical, although infusion site reactions (ISR) were higher (20.3%‐23.3%) than preceding studies in both regimens. Conclusion In combination with dexamethasone and Fos, this study suggests that palonosetron is not better than granisetron in chemo‐naive patients with primary breast cancer receiving AC‐based regimen. Administration of Fos in peripheral veins after AC‐based regimen increased ISR.
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Affiliation(s)
| | | | | | | | | | - Yoichi Naito
- National Cancer Center Hospital East, Kashiwa, Japan
| | | | | | | | | | | | | | | | | | | | | | - Chiyo K Imamura
- Advanced Cancer Translational Research Institute, Showa University, Tokyo, Japan
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16
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Laird CM, Glode AE, Schwarz K, Lam ET, O'Bryant CL. Evaluation of fosaprepitant-associated hypersensitivity reactions at a National Cancer Center. J Oncol Pharm Pract 2020; 26:1369-1373. [PMID: 31955703 DOI: 10.1177/1078155219895312] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION At our institution, an increased incidence of hypersensitivity reactions was reported following standardization of fosaprepitant as the preferred agent for the prophylaxis of chemotherapy induced nausea and vomiting (CINV) caused by highly emetogenic therapies. The purpose of this evaluation was to assess the incidence of systemic hypersensitivity reactions (HSRs) to fosaprepitant infusions compared to available literature. METHODS This evaluation is a retrospective review of electronic health records of adult patients who received their first dose of fosaprepitant for CINV prophylaxis beginning January 1, 2017 through June 30, 2017 at the University of Colorado Cancer Center outpatient infusion center. Subjects were identified using medication administration reports. Individual chart reviews were performed for all patients who received fosaprepitant during the specified timeframe and had a reaction reported on the same date. RESULTS A total of 868 patients received fosaprepitant in the outpatient infusion center during the study time period. Four patients (0.461%) had a systemic HSR attributed to fosaprepitant. Two of the reactions were reported as HSRs in the adverse reaction reporting system and two were found in provider notes during chart review. Due to the small sample size, risk factors for HSRs to fosaprepitant were not able to be determined. CONCLUSION The incidence of HSRs to fosaprepitant at our institution was found to be consistent with the <1% incidence currently noted in literature. Based on these findings, opportunities have been identified for education on fosaprepitant-associated HSRs, proper documentation and patient-specific precautions.
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Affiliation(s)
- Catherine Michelle Laird
- Department of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Aurora, CO, USA
| | - Ashley E Glode
- Department of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Aurora, CO, USA
| | - Kerry Schwarz
- Department of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Aurora, CO, USA.,UCHealth University of Colorado Hospital, Aurora, CO, USA
| | - Elaine T Lam
- Department of Medicine, Division of Medical Oncology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Cindy L O'Bryant
- Department of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Aurora, CO, USA
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17
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Abstract
Objectives: HTX-019 (Cinvanti®) is a novel injectable emulsion formulation of the neurokinin 1 receptor antagonist (RA) aprepitant, approved (as 30-min infusion and 2-min injection) for preventing acute and delayed chemotherapy-induced nausea and vomiting (CINV). This retrospective analysis evaluated the safety of HTX-019 administered by 2-min injection in patients with cancer.Methods: At a single center, HTX-019 was evaluated as a 2-min injection within a guideline-recommended three-drug regimen for CINV prophylaxis in patients receiving highly (HEC) or moderately emetogenic chemotherapy (MEC). Treatment-emergent adverse events (TEAEs) were assessed 0-60 minutes following initiation of HTX-019 administration, focusing on infusion-site adverse events and hypersensitivity reactions.Results: Among 600 patients (78 MEC, 522 HEC), the most common diagnoses were lung (172) and breast (129) cancer. Patients received a 2-min injection of HTX-019, followed by a 5-hydroxytryptamine type 3 RA intravenously (IV) (palonosetron or ondansetron), dexamethasone IV, and chemotherapy regimen (most common was cisplatin-containing) via a central (76%) and peripheral line (24%). No TEAEs occurred within 60 min after start of HTX-019 administration.Conclusion: HTX-019 administered by 2-min injection has a tolerable safety profile in patients with cancer, representing a viable method of HTX-019 administration for CINV prevention.
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Affiliation(s)
- Rudolph M Navari
- Division of Hematology Oncology, University of Alabama at Birmingham, Birmingham, AL, USA
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18
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Abstract
Introduction: Chemotherapy-induced nausea and vomiting is a significant clinical issue that affects patients' quality of life as well as treatment decisions. Significant improvements in the control of chemotherapy-induced nausea and vomiting have occurred in the past 15 years with the introduction of new antiemetic agents 5-HT3, receptor antagonists, neurokinin-1 receptor antagonists, and olanzapine. Oral (aprepitant, 2003; netupitant, 2014; rolapitant, 2015) neurokinin-1 receptor antagonists have been developed along with intravenous formulations (fosaprepitant, NEPA, rolapitant, HTX-019) for the prevention of chemotherapy-induced nausea and vomiting.Areas covered: This review presents a description of the safety and efficacy of rolapitant along with a comparison to the other oral and intravenous formulations of the neurokinin-1 receptor antagonists.Expert opinion: Oral rolapitant has been demonstrated in clinical trials to be safe and effective in controlling chemotherapy-induced nausea and vomiting in patients receiving moderately and highly emetogenic chemotherapy. Rolapitant has a longer half-life (180 h) than other commercially available NK-1 receptor antagonists and does not induce or inhibit CYP34A, unlike the other NK-1 receptor antagonists. Future studies may determine if these may be important clinical issues.
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Affiliation(s)
- Rudolph M Navari
- Division of Hematology Oncology, University of Alabama Birmingham School of Medicine, Experimental Therapeutics Program, UAB Comprehensive Cancer Center, Birmmingham, AL, USA
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19
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Cabanillas Stanchi KM, Ebinger M, Hartmann U, Queudeville M, Feucht J, Ost M, Koch MS, Malaval C, Mezger M, Schober S, Weber S, Michaelis S, Lange V, Lang P, Handgretinger R, Döring M. Efficacy, Safety And Feasibility Of Antiemetic Prophylaxis With Fosaprepitant, Granisetron And Dexamethasone In Pediatric Patients With Hemato-Oncological Malignancies. Drug Des Devel Ther 2019; 13:3439-3451. [PMID: 31686784 PMCID: PMC6777642 DOI: 10.2147/dddt.s214264] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 08/29/2019] [Indexed: 01/18/2023]
Abstract
Background Chemotherapy-induced nausea and vomiting (CINV) are a major burden for patients undergoing emetogenic chemotherapy. International guidelines recommend an antiemetic prophylaxis with corticosteroids, 5-HT3R-antagonists and NK1R-antagonists. The NK1R-antagonist fosaprepitant has shown favorable results in pediatric and adult patients. There is little pediatric experience with fosaprepitant. Methods This non-interventional observation study analyzed 303 chemotherapy courses administered to 83 pediatric patients with a median age of 9 years (2-17 years), who received antiemetic prophylaxis either with fosaprepitant and granisetron with or without dexamethasone (fosaprepitant group/FG; n=41), or granisetron with or without dexamethasone (control group/CG; n=42), during moderately (CINV risk 30-90%) or highly (CINV risk>90%) emetogenic chemotherapy. The two groups' results were compared with respect to the safety and efficacy of the antiemetic prophylaxis during the acute (0-24hrs after chemotherapy), delayed (>24-120hrs after chemotherapy) and both CINV phases. Laboratory and clinical adverse events were compared between the two cohorts. Results Adverse events were not significantly different in the two groups (p>0.05). Significantly fewer vomiting events occurred during antiemetic prophylaxis with fosaprepitant in the acute (23 vs 142 events; p<0.0001) and the delayed (71 vs 255 events; p<0.0001) CINV phase. In the control group, the percentage of chemotherapy courses with vomiting was significantly higher during the acute (24%/FG vs 45%/CG; p<0.0001) and delayed CINV phase (28%/FG vs 47%/CG; p=0.0004). Dimenhydrinate (rescue medication) was administered significantly more often in the CG, compared to the FG (114/FG vs 320/CG doses; p<0.0001). Likewise, in the control group, dimenhydrinate was administered in significantly more (p<0.0001) chemotherapy courses during the acute and delayed CINV phases (79 of 150; 52.7%), compared to the fosaprepitant group (45 of 153; 29.4%). Conclusion Antiemetic prophylaxis with fosaprepitant and granisetron with or without dexamethasone was well tolerated, safe and effective in pediatric patients. However, larger prospective trials are needed to evaluate these findings.
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Affiliation(s)
| | - Martin Ebinger
- Department of General Pediatrics, Hematology/Oncology, University Children's Hospital Tübingen, Tübingen 72076, Germany
| | - Ulrike Hartmann
- University Pharmacy, Eberhard-Karls-University of Tübingen, Tübingen 72076, Germany
| | - Manon Queudeville
- Department of General Pediatrics, Hematology/Oncology, University Children's Hospital Tübingen, Tübingen 72076, Germany
| | - Judith Feucht
- Department of General Pediatrics, Hematology/Oncology, University Children's Hospital Tübingen, Tübingen 72076, Germany
| | - Michael Ost
- Department of General Pediatrics, Hematology/Oncology, University Children's Hospital Tübingen, Tübingen 72076, Germany
| | - Marie-Sarah Koch
- Department of General Pediatrics, Hematology/Oncology, University Children's Hospital Tübingen, Tübingen 72076, Germany
| | - Carmen Malaval
- Department of General Pediatrics, Hematology/Oncology, University Children's Hospital Tübingen, Tübingen 72076, Germany
| | - Markus Mezger
- Department of General Pediatrics, Hematology/Oncology, University Children's Hospital Tübingen, Tübingen 72076, Germany
| | - Sarah Schober
- Department of General Pediatrics, Hematology/Oncology, University Children's Hospital Tübingen, Tübingen 72076, Germany
| | - Simone Weber
- Department of General Pediatrics, Hematology/Oncology, University Children's Hospital Tübingen, Tübingen 72076, Germany
| | - Sebastian Michaelis
- Department of General Pediatrics, Hematology/Oncology, University Children's Hospital Tübingen, Tübingen 72076, Germany
| | - Veit Lange
- Department of General Pediatrics, Hematology/Oncology, University Children's Hospital Tübingen, Tübingen 72076, Germany
| | - Peter Lang
- Department of General Pediatrics, Hematology/Oncology, University Children's Hospital Tübingen, Tübingen 72076, Germany
| | - Rupert Handgretinger
- Department of General Pediatrics, Hematology/Oncology, University Children's Hospital Tübingen, Tübingen 72076, Germany
| | - Michaela Döring
- Department of General Pediatrics, Hematology/Oncology, University Children's Hospital Tübingen, Tübingen 72076, Germany
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20
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Edwards JK, Bossaer JB, Lewis PO, Sant A. Peripheral neuropathy in non-Hodgkin's lymphoma patients receiving vincristine with and without aprepitant/ fosaprepitant. J Oncol Pharm Pract 2019; 26:809-813. [PMID: 31446866 DOI: 10.1177/1078155219870840] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Peripheral neuropathy is a common treatment-related adverse effect associated with vincristine. Vincristine is a major CYP3A4 substrate and is often administered alongside the neurokinin-1 (NK-1) receptor antagonists, aprepitant or fosaprepitant, which are moderate CYP3A4 inhibitors. This inhibition may result in increased concentrations of vincristine and an increased incidence of toxicity. OBJECTIVE The primary objective of this study was to investigate if there is a clinically significant drug interaction between vincristine and aprepitant or fosaprepitant resulting in early-onset peripheral neuropathy. The secondary objective of this study was to investigate the cumulative rate of chemotherapy-induced peripheral neuropathy (CIPN). METHODOLOGY This was a single-centered, retrospective, cohort chart review. Patients receiving vincristine-based chemotherapy between 1 July 2010 through 30 June 2018 were identified and reviewed for concomitant use of aprepitant or fosaprepitant and incidence of neuropathy. Early-onset CIPN was defined as neuropathy onset during the first cycle of chemotherapy. RESULTS A total of 115 subjects were retrospectively reviewed over the study period, of whom 71 were included in the aprepitant/fosaprepitant group and 44 were included in the group without a NK-1 receptor antagonist. Of the subjects who received aprepitant/fosaprepitant, 26.7% experienced early-onset peripheral neuropathy as compared to 22.7% in the group without a NK-1 receptor antagonist (P = 0.627). Overall, CIPN was higher in the group who received aprepitant/fosaprepitant compared to the group without (56% vs. 36%, P = 0.036). CONCLUSION There appears to be an increased risk of CIPN with the concomitant use of vincristine and aprepitant or fosaprepitant.
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Affiliation(s)
| | - John B Bossaer
- Bill Gatton College of Pharmacy, East Tennessee St. University, Johnson City, TN, USA
| | - Paul O Lewis
- Department of Infectious Diseases, Johnson City Medical Center, Johnson City, TN, USA
| | - Ashley Sant
- Department of Oncology, Johnson City Medical Center, Johnson City, TN, USA
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Yamasaki M, Kimura R, Mayahara S, Maeda Y, Takahashi M, Nishida T, Oda K, Murakami T. Study on the infusion-site adverse events and vascular distribution of epirubicin in chemotherapy with epirubicin and fosaprepitant. Mol Clin Oncol 2019; 11:43-49. [PMID: 31289676 PMCID: PMC6535639 DOI: 10.3892/mco.2019.1849] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Accepted: 04/15/2019] [Indexed: 11/06/2022] Open
Abstract
In breast cancer patients on a fluorouracil-epirubicin (EPI)-cyclophosphamide (FEC) regimen and intravenous fosaprepitant (FAP) during chemotherapy, infusion-site adverse events such as vascular pain and induration and/or phlebitis are observed. In the present study, adverse events induced by the FEC regimen and FAP, a prodrug of aprepitant (AP), were studied based on the vascular tissue distribution of EPI in rats. Rats were treated with intravenous FAP (3 mg/kg, 10 min-constant rate infusion) or oral AP (3 mg/kg) and then intravenous EPI (1 mg/kg, 5 min-constant rate infusion) as follows: FAP-S Group, FAP and then EPI was infused from the same site on the jugular vein; FAP-D Group, FAP and then EPI was infused from different jugular veins (left and right); and AP Group, AP was administered orally and EPI was infused from the jugular vein. Concentrations of EPI in vascular tissue at the EPI infusion sites and opposite sites of the jugular vein (left and right, respectively) were measured at 30 min and 24 h after EPI infusion. Histological observation of the EPI infusion site was also made separately. In rats, the tissue concentrations of EPI at the infusion site in the FAP-S group were higher than those in the FAP-D and AP groups. Inflammation and necrosis were observed at the EPI infusion-site vascular tissue of the FAP-S group, but not of the FAP-D and AP groups. These findings could aid the development of an approach to avoid infusion-site adverse events in anthracycline-based chemotherapy in the clinical practice.
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Affiliation(s)
- Miho Yamasaki
- Department of Pharmacy, Chugoku Rosai Hospital, Kure, Hiroshima 737-0193, Japan
| | - Ryuji Kimura
- Department of Pharmacy, Chugoku Rosai Hospital, Kure, Hiroshima 737-0193, Japan
| | - Shigeri Mayahara
- Department of Pharmacy, Chugoku Rosai Hospital, Kure, Hiroshima 737-0193, Japan
| | - Yorinobu Maeda
- Department of Pharmacy, Chugoku Rosai Hospital, Kure, Hiroshima 737-0193, Japan
| | - Mamoru Takahashi
- Department of Breast Surgery, Chugoku Rosai Hospital, Kure, Hiroshima 737-0193, Japan
| | - Toshihiro Nishida
- Department of Diagnostic Pathology, Chugoku Rosai Hospital, Kure, Hiroshima 737-0193, Japan
| | - Keisuke Oda
- Laboratory of Biopharmaceutics and Pharmacokinetics, Faculty of Pharmaceutical Sciences, Hiroshima International University, Kure, Hiroshima 737-0112, Japan
| | - Teruo Murakami
- Laboratory of Biopharmaceutics and Pharmacokinetics, Faculty of Pharmaceutical Sciences, Hiroshima International University, Kure, Hiroshima 737-0112, Japan
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Mora J, Valero M, DiCristina C, Jin M, Chain A, Bickham K. Pharmacokinetics/pharmacodynamics, safety, and tolerability of fosaprepitant for the prevention of chemotherapy-induced nausea and vomiting in pediatric cancer patients. Pediatr Blood Cancer 2019; 66:e27690. [PMID: 30900392 DOI: 10.1002/pbc.27690] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 02/01/2019] [Accepted: 02/15/2019] [Indexed: 11/08/2022]
Abstract
BACKGROUND Current antiemetic regimens are less effective in children than in adults. Fosaprepitant was recently approved for prevention of chemotherapy-induced nausea and vomiting (CINV) in children aged six months and older. PROCEDURE The pharmacokinetic (PK)/pharmacodynamic (PD) profile, safety, and tolerability of a single intravenous dose of fosaprepitant administered concomitantly with ondansetron with/without dexamethasone were evaluated in pediatric patients with cancer receiving emetogenic chemotherapy. PK/PD from three doses of fosaprepitant (3.0, 1.2, and 0.4 mg/kg, up to 150, 60, and 20 mg, respectively) were compared with placebo in 2- to 17-year-old subjects; an open-label amendment evaluated a fourth dose (5.0 mg/kg, up to 150 mg) in those under 12 years old. Historical adult PK data were used for comparison. Efficacy was measured as an exploratory endpoint. RESULTS PK data were evaluable for 167/234 subjects who completed cycle one. Aprepitant exposures were dose proportional; adolescents (12 to 17 years) receiving fosaprepitant 150 mg had exposures similar to adults at the same dose. Higher weight-normalized doses (5 mg/kg) were necessary for children aged < 12 years to achieve comparable adult exposures. The adverse event profile was typical of cancer patients receiving emetogenic chemotherapy. Drug-related adverse events were reported in 16 (6.8%) subjects, with hiccups being most common (n = 5; 2.1%). CONCLUSIONS Intravenous fosaprepitant was well tolerated by pediatric subjects with cancer, and dose-proportional exposures were observed. Subjects < 12 years old required higher doses to achieve comparable adult exposures.
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Affiliation(s)
- Jaume Mora
- Department of Pediatric Oncology, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Miguel Valero
- Department of Pediatrics, Unit of Hematology and Oncology, Hospital Carlos Van Buren de Valparaíso, Valparaíso, Chile
| | | | - Mandy Jin
- Merck & Co., Inc., Kenilworth, New Jersey
| | - Anne Chain
- Merck & Co., Inc., Kenilworth, New Jersey
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Kashiwa M, Matsushita R. Comparative Cost-utility Analysis Between Aprepitant- and Fosaprepitant-containing Regimens To Prevent Chemotherapy-induced Nausea and Vomiting in Patients Receiving Highly Emetogenic Chemotherapy in Japan. Clin Ther 2019; 41:929-942. [PMID: 31036286 DOI: 10.1016/j.clinthera.2019.03.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Revised: 01/29/2019] [Accepted: 03/17/2019] [Indexed: 11/28/2022]
Abstract
PURPOSE Clinical trials have shown that the addition of aprepitant (APR) or a phosphorylated prodrug of aprepitant, fosaprepitant (FosAPR) as prophylactic antiemetic therapy consisting of a 5-hydrotryptamine-3 receptor antagonist and dexamethasone is effective in patients receiving highly emetogenic chemotherapy. These combination therapies have been commonly used in Japan. In the present study, we performed a cost-utility analysis of APR and FosAPR in the context of the Japanese medical insurance system, and economic efficiency was compared. METHODS Data from randomized controlled trials that examined the efficacy of APR and FosAPR in the Japanese population were used. A decision tree was constructed to estimate the effectiveness of chemotherapy for 5 days from the day of the treatment and the cost associated with outpatient chemotherapy from the perspective of a payer. Health outcome was expressed in quality-adjusted life-years (QALYs), and costs were estimated based on medical fees and drug prices from 2018. An incremental cost-effectiveness ratio (ICER) was calculated for each regimen containing either APR or FosAPR. The robustness of the model was assessed using 1-way and probabilistic sensitivity analysis. FINDINGS The base-case analysis estimated that the addition of APR or FosAPR would have incremental effects of 0.00166 and 0.00143 QALY and incremental costs of 8305 and 11,348 JPY (74 and 101 USD [1 USD = 112.17 JPY]), resulting in ICERs of 4,992,172 and 7,955,560 JPY/QALY (44,505 and 70,924 USD/QALY), respectively. Sensitivity analysis revealed that the probability of a complete response for delayed chemotherapy-induced nausea and vomiting had the most influence on the ICERs. Reductions in the drug costs of APR and FosAPR also had an effect on the ICERs. According to the probabilistic sensitivity analysis, APR and FosAPR were dominant in terms of cost-effectiveness in 48.7% and 8.55% of cases, respectively. IMPLICATIONS The ICER of outpatient prophylactic antiemetic therapy in patients receiving highly emetogenic chemotherapy was calculated in the context of the Japanese medical insurance system. Assuming the willingness-to-pay of 5,000,000 JPY/QALY based on the calculated ICER, our findings suggest that although the addition of APR is cost-effective, FosAPR is not cost-effective.
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Affiliation(s)
- Munenobu Kashiwa
- Division of Pharmacy, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan; Department of Pharmacy, First Towakai Hospital, Takatsuki, Japan
| | - Ryo Matsushita
- Division of Pharmaceutical Sciences, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan.
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Radhakrishnan V, Joshi A, Ramamoorthy J, Rajaraman S, Ganesan P, Ganesan TS, Dhanushkodi M, Sagar TG. Intravenous fosaprepitant for the prevention of chemotherapy-induced vomiting in children: A double-blind, placebo-controlled, phase III randomized trial. Pediatr Blood Cancer 2019; 66:e27551. [PMID: 30426714 DOI: 10.1002/pbc.27551] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 10/11/2018] [Accepted: 10/25/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND Fosaprepitant is a neurokinin-1 receptor antagonist, approved for the prevention of chemotherapy-induced nausea and vomiting. The data on the use of fosaprepitant in children are limited and therefore we conducted a phase III randomized controlled trial. PROCEDURE Children aged 1-12 years scheduled to receive moderately or highly emetogenic chemotherapy were randomly assigned to arm-A (fosaprepitant) or arm-B (placebo). Children recruited to arm-A received intravenous ondansetron plus dexamethasone followed by fosaprepitant infusion. Children recruited to arm-B received the same drugs as those given to children in arm-A, except that fosaprepitant was substituted with a placebo. Ondansetron and dexamethasone were continued for 48 hours after completion of chemotherapy. The primary end point of the study was to determine the proportion of patients who achieved a complete response (CR), defined as no vomiting, no retching, and no use of rescue medication, during the 24-120 hours (delayed phase) after administration of the last dose of chemotherapy. Secondary end points were the proportion of patients who achieved a CR during the acute phase (0-24 hours) and overall after administration of the last dose of chemotherapy. RESULTS One-hundred-sixty-three patients were analyzed (81 in the fosaprepitant arm and 82 in the placebo arm). CR rates were significantly higher in the fosaprepitant arm compared to those in the placebo arm during the acute phase (86% vs 60%, P < 0.001), delayed phase (79% vs 51%, P < 0.001), and overall phase (70% vs 41%, P < 0.001). Three (4%) patients in the fosaprepitant arm and sixteen (20%) in the placebo arm required rescue anti-emetics (P = 0.0017). CONCLUSION Addition of fosaprepitant to ondansetron and dexamethasone improved chemotherapy-induced vomiting control in children treated with moderately or highly emetogenic chemotherapy.
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Affiliation(s)
- Venkatraman Radhakrishnan
- Department of Medical Oncology (Pediatric Oncology Division), Cancer Institute (WIA), Chennai, India
| | - Archit Joshi
- Department of Medical Oncology (Pediatric Oncology Division), Cancer Institute (WIA), Chennai, India
| | - Jaikumar Ramamoorthy
- Department of Medical Oncology (Pediatric Oncology Division), Cancer Institute (WIA), Chennai, India
| | | | - Prasanth Ganesan
- Department of Medical Oncology (Pediatric Oncology Division), Cancer Institute (WIA), Chennai, India
| | - Trivadi S Ganesan
- Department of Medical Oncology (Pediatric Oncology Division), Cancer Institute (WIA), Chennai, India
| | - Manikandan Dhanushkodi
- Department of Medical Oncology (Pediatric Oncology Division), Cancer Institute (WIA), Chennai, India
| | - Tenali G Sagar
- Department of Medical Oncology (Pediatric Oncology Division), Cancer Institute (WIA), Chennai, India
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Saito Y, Kumamoto T, Arima T, Shirakawa N, Ishimaru S, Sonoda T, Nakajima M, Sugiyama M, Arakawa A, Hashimoto H, Makino Y, Ogawa C, Yamaguchi M. Evaluation of aprepitant and fosaprepitant in pediatric patients. Pediatr Int 2019; 61:235-239. [PMID: 30615239 DOI: 10.1111/ped.13780] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 11/26/2018] [Accepted: 12/28/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Single-dose i.v. fosaprepitant has been approved as an alternative to 3 day oral aprepitant, a neurokinin-1 receptor antagonist, and improves prevention of chemotherapy-induced nausea and vomiting (CINV). Because fosaprepitant has shown similar efficacy to aprepitant in adult patients only, this study compared the efficacy and safety of aprepitant and fosaprepitant in pediatric patients. METHODS Children younger than 18 years who received aprepitant or fosaprepitant to manage CINV between January 2015 and March 2018 at the National Cancer Center Hospital (Tokyo) were recruited to this study. The primary endpoint was complete response (CR; no vomiting/rescue medication) between 0 and 120 h after the start of chemotherapy. Secondary endpoints were safety based on the frequency of severe adverse events, and evaluation of patient characteristics as risk factors (effect of age and sex). RESULTS A total of 125 chemotherapy cycles were evaluated. In the aprepitant group, CR was observed in 36 of 80 treatment cycles (45.0%), whereas in the fosaprepitant group, it was observed in 19 of 45 cycles (42.2%; P = 0.852). No treatment-related severe adverse events were observed in either group. The number of non-CR was greater than that of CR in patients aged 6-14 years. The difference in CR rate between male and female patients was not statistically significant (47.1% vs 40.0%, respectively; P = 0.471). CONCLUSIONS Aprepitant and fosaprepitant were safely used and may be equally useful for pediatric patients receiving highly emetogenic chemotherapy. CR rate may be associated with patient age.
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Affiliation(s)
- Yoshimasa Saito
- Department of Pharmacy, National Cancer Center Hospital, Tokyo, Japan
| | - Tadashi Kumamoto
- Department of Pediatric Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Takamichi Arima
- Department of Pharmacy, National Cancer Center Hospital, Tokyo, Japan
| | - Nami Shirakawa
- Department of Pediatric Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Sae Ishimaru
- Department of Pediatric Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Tomoko Sonoda
- Department of Pediatric Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Miho Nakajima
- Department of Pediatric Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Masanaka Sugiyama
- Department of Pediatric Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Ayumu Arakawa
- Department of Pediatric Oncology, National Cancer Center Hospital, Tokyo, Japan
| | | | - Yoshinori Makino
- Department of Pharmacy, National Cancer Center Hospital, Tokyo, Japan
| | - Chitose Ogawa
- Department of Pediatric Oncology, National Cancer Center Hospital, Tokyo, Japan
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IV aprepitant (Cinvanti) for chemotherapy-induced nausea and vomiting. Med Lett Drugs Ther 2018; 60:e200-1. [PMID: 30653479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
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Abstract
To examine pharmacologic and clinical characteristics of neurokinin 1 (NK1)-receptor antagonists (RAs) for preventing chemotherapy-induced nausea and vomiting (CINV) following highly or moderately emetogenic chemotherapy, a literature search was performed for clinical studies in patients at risk of CINV with any approved NK1 RAs in the title or abstract: aprepitant (capsules or oral suspension), HTX019 (intravenous [IV] aprepitant), fosaprepitant (IV aprepitant prodrug), rolapitant (tablets or IV), and fixed-dose tablets combining netupitant or fosnetupi-tant (IV netupitant prodrug) with the 5-hydroxytryptamine type 3 (5HT3) RA palonosetron (oral or IV). All NK1 RAs are effective, but exhibit important differences in efficacy against acute and delayed CINV. The magnitude of benefit of NK1-RA-containing three-drug vs two-drug regimens is greater for delayed vs acute CINV. Oral rolapitant has the longest half-life of available NK1 RAs, but as a consequence should not be administered more frequently than every 2 weeks. In general, NK1 RAs are well tolerated; however, IV rolapitant was recently removed from US distribution, due to hypersensitivity and anaphylaxis, and IV fosaprepitant is associated with infusion-site reactions and hypersensitivity presumed related to its polysorbate 80 excipient. Also, available NK1 RAs have potential drug–drug interactions. Adding an NK1 RA to 5HT3 RA and dexamethasone significantly improves CINV control vs the two-drug regimen. Newer NK1 RAs offer more formulation options, higher acute-phase plasma levels, or improved tolerability, and increase clinicians’ opportunities to maximize benefits of this important class of antiemetics.
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Affiliation(s)
- Rudolph M Navari
- Department of Hematology/ Oncology, University of Alabama at Birmingham, Birmingham, AL, USA,
| | - Lee S Schwartzberg
- Division of Hematology/Oncology, Department of Medicine, University of Tennessee Health Science Center and West Cancer Center, Memphis, TN, USA
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Kono T, Ueda T, Takumida M, Furuie H, Hamamoto T, Takeno S, Hirakawa K. Low-dose dexamethasone with fosaprepitant and palonosetron to prevent cisplatin-induced nausea and vomiting in head and neck cancer patients. Acta Otolaryngol 2018; 138:921-925. [PMID: 30016902 DOI: 10.1080/00016489.2018.1482423] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To determine if a lower dose of dexamethasone can be used in combination with fosaprepitant and palonosetron for cisplatin-induced nausea and vomiting in head and neck cancer patients, we conducted a single-center, two-arm, cross-over comparison study. METHODS Patients were randomly assigned to either standard dose dexamethasone group: intravenous 9.9 mg on day 1 and 6.6 mg on days 2-4 or low-dose dexamethasone group: intravenous 3.3 mg on days 1-4 for the first course and crossed over to the other treatment for the second course. The primary endpoint was complete response (CR) in the overall period. RESULTS Twenty-five patients were screened for the study and 22 were evaluable. Eleven patients were randomly assigned to the standard dose dexamethasone group and 12 patients to the low-dose dexamethasone group. The CR rate in the overall period was 86% in the standard dose group and 73% in the low-dose group, showing no significant difference (p = .61). CONCLUSION The efficacy of low-dose dexamethasone with fosaprepitant and palonosetron was not inferior to that of the standard dose dexamethasone in the highly emetogenic cisplatin-based treatment for head and neck cancer patients.
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Affiliation(s)
- Takashi Kono
- Department of Otorhinolaryngology, Head and Neck Surgery, Hiroshima University Hospital, Hiroshima, Japan
| | - Tsutomu Ueda
- Department of Otorhinolaryngology, Head and Neck Surgery, Hiroshima University Hospital, Hiroshima, Japan
| | - Masaya Takumida
- Department of Otorhinolaryngology, Head and Neck Surgery, Hiroshima University Hospital, Hiroshima, Japan
| | - Hiromi Furuie
- Department of Otorhinolaryngology, Head and Neck Surgery, Hiroshima University Hospital, Hiroshima, Japan
| | - Takao Hamamoto
- Department of Otorhinolaryngology, Head and Neck Surgery, Hiroshima University Hospital, Hiroshima, Japan
| | - Sachio Takeno
- Department of Otorhinolaryngology, Head and Neck Surgery, Hiroshima University Hospital, Hiroshima, Japan
| | - Katsuhiro Hirakawa
- Department of Otorhinolaryngology, Head and Neck Surgery, Hiroshima University Hospital, Hiroshima, Japan
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Henssen AG, Odersky A, Szymansky A, Seiler M, Althoff K, Beckers A, Speleman F, Schäfers S, De Preter K, Astrahanseff K, Struck J, Schramm A, Eggert A, Bergmann A, Schulte JH. Targeting tachykinin receptors in neuroblastoma. Oncotarget 2018; 8:430-443. [PMID: 27888795 PMCID: PMC5352132 DOI: 10.18632/oncotarget.13440] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [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] [Received: 06/29/2016] [Accepted: 11/12/2016] [Indexed: 01/23/2023] Open
Abstract
Neuroblastoma is the most common extracranial tumor in children. Despite aggressive multimodal treatment, high-risk neuroblastoma remains a clinical challenge with survival rates below 50%. Adding targeted drugs to first-line therapy regimens is a promising approach to improve survival in these patients. TACR1 activation by substance P has been reported to be mitogenic in cancer cell lines. Tachykinin receptor (TACR1) antagonists are approved for clinical use as an antiemetic remedy since 2003. Tachykinin receptor inhibition has recently been shown to effectively reduce growth of several tumor types. Here, we report that neuroblastoma cell lines express TACR1, and that targeting TACR1 activity significantly reduced cell viability and induced apoptosis in neuroblastoma cell lines. Gene expression profiling revealed that TACR1 inhibition repressed E2F2 and induced TP53 signaling. Treating mice harboring established neuroblastoma xenograft tumors with Aprepitant also significantly reduced tumor burden. Thus, we provide evidence that the targeted inhibition of tachykinin receptor signaling shows therapeutic efficacy in preclinical models for high-risk neuroblastoma.
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Affiliation(s)
- Anton G Henssen
- Molecular Pharmacology Program, Sloan Kettering Institute, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Andrea Odersky
- Department of Pediatric Oncology and Hematology, University Children's Hospital Essen, Germany
| | - Annabell Szymansky
- Department of Pediatric Oncology/Hematology, Charité- Universitätsmedizin Berlin, Germany
| | | | - Kristina Althoff
- Department of Pediatric Oncology and Hematology, University Children's Hospital Essen, Germany
| | - Anneleen Beckers
- Center of Medical Genetics Ghent (CMGG), Ghent University Hospital, Belgium
| | - Frank Speleman
- Center of Medical Genetics Ghent (CMGG), Ghent University Hospital, Belgium
| | - Simon Schäfers
- Department of Pediatric Oncology and Hematology, University Children's Hospital Essen, Germany
| | - Katleen De Preter
- Center of Medical Genetics Ghent (CMGG), Ghent University Hospital, Belgium
| | - Kathy Astrahanseff
- Department of Pediatric Oncology/Hematology, Charité- Universitätsmedizin Berlin, Germany
| | | | - Alexander Schramm
- Department of Pediatric Oncology and Hematology, University Children's Hospital Essen, Germany
| | - Angelika Eggert
- Department of Pediatric Oncology/Hematology, Charité- Universitätsmedizin Berlin, Germany.,German Consortium for Translational Cancer Research (DKTK), Partner Site Charite Berlin, Berlin, Germany
| | | | - Johannes H Schulte
- Department of Pediatric Oncology/Hematology, Charité- Universitätsmedizin Berlin, Germany.,German Consortium for Translational Cancer Research (DKTK), Partner Site Charite Berlin, Berlin, Germany
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30
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Patel P, Leeder JS, Piquette-Miller M, Dupuis LL. Response to 'Aprepitant and fosaprepitant decrease the effectiveness of hormonal contraceptives'. Br J Clin Pharmacol 2018; 84:604. [PMID: 29315725 DOI: 10.1111/bcp.13487] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Accepted: 12/07/2017] [Indexed: 11/29/2022] Open
Affiliation(s)
- Priya Patel
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada.,Department of Pharmacy, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - J Steven Leeder
- Division of Clinical Pharmacology, Toxicology & Therapeutic Innovation, Department of Pediatrics, Children's Mercy-Kansas City, Kansas City, MO, USA.,School of Medicine, University of Missouri-Kansas City, Kansas City, MO, USA
| | | | - L Lee Dupuis
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada.,Department of Pharmacy, The Hospital for Sick Children, Toronto, Ontario, Canada.,Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
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Patel P, Leeder JS, Piquette‐Miller M, Dupuis LL. Aprepitant and fosaprepitant drug interactions: a systematic review. Br J Clin Pharmacol 2017; 83:2148-2162. [PMID: 28470980 PMCID: PMC5595939 DOI: 10.1111/bcp.13322] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [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: 01/05/2017] [Revised: 04/12/2017] [Accepted: 04/21/2017] [Indexed: 12/12/2022] Open
Abstract
AIMS Aprepitant and fosaprepitant, commonly used for the prevention of chemotherapy-induced nausea and vomiting, alter cytochrome P450 activity. This systematic review evaluates clinically significant pharmacokinetic drug interactions with aprepitant and fosaprepitant and describes adverse events ascribed to drug interactions with aprepitant or fosaprepitant. METHODS We systematically reviewed the literature to September 11, 2016, to identify articles evaluating drug interactions involving aprepitant/fosaprepitant. The clinical significance of each reported pharmacokinetic drug interaction was evaluated based on the United States Food and Drug Administration guidance document on conducting drug interaction studies. The probability of an adverse event reported in case reports being due to a drug interaction with aprepitant/fosaprepitant was determined using the Drug Interaction Probability Scale. RESULTS A total of 4377 publications were identified. Of these, 64 met inclusion eligibility criteria: 34 described pharmacokinetic drug interactions and 30 described adverse events ascribed to a drug interaction. Clinically significant pharmacokinetic interactions between aprepitant/fosaprepitant and bosutinib PO, cabazitaxel IV, cyclophosphamide IV, dexamethasone PO, methylprednisolone IV, midazolam PO/IV, oxycodone PO and tolbutamide PO were identified, as were adverse events resulting from an interaction between aprepitant/fosaprepitant and alcohol, anthracyclines, ifosfamide, oxycodone, quetiapine, selective serotonin reuptake inhibitors/serotonin-norepinephrine reuptake inhibitors and warfarin. CONCLUSIONS The potential for a drug interaction with aprepitant and fosaprepitant should be considered when selecting antiemetic therapy.
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Affiliation(s)
- Priya Patel
- Leslie Dan Faculty of PharmacyUniversity of TorontoTorontoOntarioCanada
- Department of PharmacyThe Hospital for Sick ChildrenTorontoOntarioCanada
| | - J. Steven Leeder
- Division of Clinical Pharmacology, Toxicology & Therapeutic Innovation, Department of PediatricsChildren's Mercy‐Kansas CityKansas CityMissouriUSA
- School of MedicineUniversity of Missouri‐Kansas CityKansas CityMissouriUSA
| | | | - L. Lee Dupuis
- Leslie Dan Faculty of PharmacyUniversity of TorontoTorontoOntarioCanada
- Department of PharmacyThe Hospital for Sick ChildrenTorontoOntarioCanada
- Child Health Evaluative Sciences, Research InstituteThe Hospital for Sick ChildrenTorontoOntarioCanada
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32
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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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33
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Sorooshian H, Vo L. A modified olanzapine regimen for the prevention of chemotherapy-induced nausea and vomiting. J Community Support Oncol 2016; 13:388-91. [PMID: 26863018 DOI: 10.12788/jcso.0194] [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] [Subscribe] [Scholar Register] [Accepted: 08/03/2015] [Indexed: 11/20/2022]
Abstract
BACKGROUND At Kaiser Permanente Antioch and Walnut Creek Cancer Centers, a modified olanzapine regimen is used to prevent chemotherapy-induced nausea and vomiting (CINV) in patients who receive highly emetogenic chemotherapy (HEC). OBJECTIVE To determine if an olanzapine, ondansetron, dexamethasone (OOD) regimen is noninferior to a fosaprepitant, ondansetron, dexamethasone (FOD) regimen in preventing CINV in patients receiving HEC. METHODS This retrospective cohort study compared the rates of CINV in patients who were treated with HEC and received either the OOD or FOD regimen. Electronic medical records were assessed for documented reports of CINV. 148 patients were included in this study. RESULTS Complete response (CR), defined as no emesis after Cycle 1 of HEC, in patients receiving the OOD regimen was 95.7% in the acute phase, 94.3% in the delayed phase, and 92.9% overall. CR in patients receiving the FOD regimen was 98.7% in the acute phase, 89.7% in the delayed phase, and 89.7% overall. The percentage of patients who had no nausea on the OOD regimen was 87.1 in the acute phase, 75.5 in the delayed phase, and 71.4 overall, compared with 78.2 in the acute phase, 62.8 in the delayed phase, and 62.7 overall in patients on the FOD regimen. LIMITATIONS This study was limited by its retrospective, nonrandomized design, and short follow-up period. This study did not assess adverse effects from the antiemetic regimens. CONCLUSIONS A modified olanzapine regimen is noninferior to a standard fosaprepitant regimen in regard to CR in showing improved control of CINV. In addition, the use of the olanzapine regimen reduces patient exposure to corticosteroids and the risk of associated side effects, and it is significantly more cost effective, compared with the fosaprepitant regimen.
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Affiliation(s)
| | - Long Vo
- Kaiser Permanente-Diablo Service Area, Walnut Creek, California, USA.
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34
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Candelario N, Lu MLR. Fosaprepitant dimeglumine for the management of chemotherapy-induced nausea and vomiting: patient selection and perspectives. Cancer Manag Res 2016; 8:77-82. [PMID: 27382332 PMCID: PMC4922819 DOI: 10.2147/cmar.s93620] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Chemotherapy-induced nausea and vomiting (CINV) is a debilitating side effect of antineoplastic agents. Several treatment regimens are used to address this problem. Fosaprepitant is a neurokinin-1 receptor blocker used in the prevention and treatment of CINV, especially for moderately and severely emetogenic chemotherapy. It is highly effective in the treatment of delayed CINV. Data from previous studies show that fosaprepitant is noninferior to aprepitant in the management of CINV. Fosaprepitant is given as a single-dose intravenous infusion, thus offering better patient compliance. The dose-limiting side effect of fosaprepitant is an infusion-related reaction, ranging from pain at the infusion site to thrombophlebitis. This side effect has been reported with coadministration of anthracycline agents.
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Dushenkov A, Kalabalik J, Carbone A, Jungsuwadee P. Drug interactions with aprepitant or fosaprepitant: Review of literature and implications for clinical practice. J Oncol Pharm Pract 2016; 23:296-308. [PMID: 26921085 DOI: 10.1177/1078155216631408] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose Aprepitant and its parenteral formulation fosaprepitant are widely used for the prevention of chemotherapy-induced nausea and vomiting. Aprepitant exerts modest inhibitory effect on CYP3A4 and modest inductive effect on CYP2C9 substrates such as some antineoplastics and multiple other medications. This article is aimed to provide pharmacists and other healthcare professionals with an updated summary of drug-drug interactions of aprepitant/fosaprepitant and implications for clinical practice. Method We reviewed publications reporting drug-drug interactions between aprepitant/fosaprepitant and other medications. Results Coadministration of aprepitant with antineoplastics or opiods may result in significant elevations in the serum levels of the agents metabolized via CYP3A4, with the best documentation for cyclophosphamide, ifosfamide, erlotinib and oxycodone. These alterations did not translate into adverse outcomes and/or necessitate dosing adjustments. The levels of warfarin were significantly decreased by aprepitant requiring prolonged monitoring after discontinuation of aprepitant. Among direct oral anticoagulants, a theoretical interaction between aprepitant and rivaroxaban or apixaban exists. Interactions between aprepitant and quetiapine or diltiazem or sirolimus required dose reductions to avoid adverse outcomes. The intravenous route had a weaker inhibitory effect on CYP3A4 than the oral pathway. Conclusion The evidence on drug interactions of aprepitant with other medications is limited, and the impact on therapeutic outcomes remains to be determined. The intravenous regimen may be a preferred option. As utilization of aprepitant is expanding, practitioners and patients need to be educated about the potential for drug interactions and a need for careful monitoring of patients concurrently receiving aprepitant and CYP2C9 or CYP3A4 substrates, especially those with a narrow therapeutic window.
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Affiliation(s)
- Anna Dushenkov
- School of Pharmacy, Fairleigh Dickinson University, NJ, USA
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36
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Tsuda T, Kyomori C, Mizukami T, Taniyama T, Izawa N, Horie Y, Hirakawa M, Ogura T, Nakajima TE, Tsugawa K, Boku N. Infusion site adverse events in breast cancer patients receiving highly emetic chemotherapy with prophylactic anti-emetic treatment with aprepitant and fosaprepitant: A retrospective comparison. Mol Clin Oncol 2016; 4:603-606. [PMID: 27073673 DOI: 10.3892/mco.2016.769] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 01/18/2016] [Indexed: 11/06/2022] Open
Abstract
The incidences of infusion site adverse events in chemotherapy regimens, including anthracyclines with either fosaprepitant or aprepitant as the anti-emetic, were not highlighted in the randomized trial comparing aprepitant and fosaprepitant. The present retrospective analysis was performed in breast cancer patients receiving anthracycline-containing chemotherapy, a combination of epirubicin and cyclophosphamide with or without 5-fluorouracil as the adjuvant or neoadjuvant, at the outpatient infusion center of St. Marianna University Hospital (Kawasaki, Japan). Infusion site adverse events were retrospectively compared between the 3 months prior to and three months following switching from 3 day oral administration of aprepitant to intravenous infusion of fosaprepitant. A total of 62 patients were included in the aprepitant group and 38 in the fosaprepitant group. Of these patients, 26 (42%) in the aprepitant group and 36 patients (96%) in the fosaprepitant group experienced any grade of infusion site adverse events at least once (P<0.001). As an anti-emetic treatment for chemotherapy using anthracyclines, fosaprepitant may be associated with a higher risk of infusion site adverse events compared with aprepitant.
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Affiliation(s)
- Takashi Tsuda
- Department of Clinical Oncology, St. Marianna University School of Medicine, Kawasaki 216-8511, Japan
| | - Chisato Kyomori
- Department of Nursing, St. Marianna University School of Medicine, Kawasaki 216-8511, Japan
| | - Takuro Mizukami
- Department of Clinical Oncology, St. Marianna University School of Medicine, Kawasaki 216-8511, Japan
| | - Tomoko Taniyama
- Department of Clinical Oncology, St. Marianna University School of Medicine, Kawasaki 216-8511, Japan
| | - Naoki Izawa
- Department of Clinical Oncology, St. Marianna University School of Medicine, Kawasaki 216-8511, Japan
| | - Yoshiki Horie
- Department of Clinical Oncology, St. Marianna University School of Medicine, Kawasaki 216-8511, Japan
| | - Mami Hirakawa
- Department of Clinical Oncology, St. Marianna University School of Medicine, Kawasaki 216-8511, Japan
| | - Takashi Ogura
- Department of Clinical Oncology, St. Marianna University School of Medicine, Kawasaki 216-8511, Japan
| | - Takako Eguchi Nakajima
- Department of Clinical Oncology, St. Marianna University School of Medicine, Kawasaki 216-8511, Japan
| | - Koichiro Tsugawa
- Division of Breast and Endocrine Surgery, Department of Surgery, St. Marianna University School of Medicine, Kawasaki 216-8511, Japan
| | - Narikazu Boku
- Department of Clinical Oncology, St. Marianna University School of Medicine, Kawasaki 216-8511, Japan
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Abstract
Postoperative nausea and vomiting (PONV) is a debilitating condition that occurs in approximately 30% of patients undergoing general anesthesia. Premedication with 5-HT3 receptor antagonists and glucocorticoids is effective in clinical practice; however, 10% to 20% of patients still develop PONV. Currently, little is known about the treatment of refractory PONV. We present a case that illustrates the use of fosaprepitant for the treatment of refractory postoperative nausea and vomiting.
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Affiliation(s)
- Linh H Tran
- Pharmacist, Department of Pharmacy, Stanford Health Care , Stanford, California
| | - Magdalena Cudny
- Pharmacist, Department of Pharmacy, Stanford Health Care , Stanford, California
| | - Dat Ngo
- Pharmacist, Department of Pharmacy, Stanford Health Care , Stanford, California
| | - Samit Patel
- Pharmacist, Department of Pharmacy, Stanford Health Care , Stanford, California
| | - Manuel Y Lam
- Hospitalist & Clinical Instructor, Stanford Health Care , Stanford, California
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Clark SM, Clemmons AB, Schaack L, Garren J, DeRemer DL, Kota VK. Fosaprepitant for the prevention of nausea and vomiting in patients receiving BEAM or high-dose melphalan before autologous hematopoietic stem cell transplant. J Oncol Pharm Pract 2015; 22:416-22. [PMID: 25956421 DOI: 10.1177/1078155215585190] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To assess the impact of single-dose fosaprepitant on nausea and emesis after BEAM and high-dose melphalan conditioning regimens for autologous hematopoietic stem cell transplantation. METHODS In a single-center cohort study patients receiving melphalan containing hematopoietic stem cell transplantation regimens who received a one-time dose of 150 mg IV fosaprepitant (n = 56) were compared to a historical control (n = 70). RESULTS The primary endpoint of no emesis from melphalan administration through five days afterward was 80% for the fosaprepitant group versus 66% in the control group (p = 0.068). Addition of fosaprepitant demonstrated significant improvement in emetic episodes per patient during the entire assessment period (p = 0.011) and days 1-5 after melphalan (p = 0.045). Fosaprepitant resulted in no substantial nausea during the entire assessment period in 37% of high-dose melphalan patients and 57% of BEAM patients. CONCLUSIONS Further studies are suggested to investigate the optimal number and timing of doses of fosaprepitant in this setting.
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Affiliation(s)
- Stephen Michael Clark
- Department of Pharmacy, Georgia Regents Medical Center, Augusta, GA, USA Department of Clinical and Administrative Pharmacy, University of Georgia College of Pharmacy, Augusta, GA, USA Georgia Regents University Cancer Center, Augusta, GA, USA
| | - Amber B Clemmons
- Department of Pharmacy, Georgia Regents Medical Center, Augusta, GA, USA Department of Clinical and Administrative Pharmacy, University of Georgia College of Pharmacy, Augusta, GA, USA Georgia Regents University Cancer Center, Augusta, GA, USA
| | - Lindsay Schaack
- Department of Pharmacy, Grady Health System, Atlanta, GA, USA
| | - Jeonifer Garren
- Department of Biostatistics and Epidemiology, Georgia Regents University, Augusta, GA, USA
| | - David L DeRemer
- Department of Pharmacy, Georgia Regents Medical Center, Augusta, GA, USA Department of Clinical and Administrative Pharmacy, University of Georgia College of Pharmacy, Augusta, GA, USA Georgia Regents University Cancer Center, Augusta, GA, USA
| | - Vamsi K Kota
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA
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Sato Y, Kondo M, Inagaki A, Komatsu H, Okada C, Naruse K, Sahashi T, Kuroda J, Ogura H, Uegaki S, Yoshida T, Mori Y, Sawada H, Watanabe S, Sugiura H, Endo Y, Yoshimoto N, Toyama T, Iida S, Yamada K, Kimura K, Wakita A. Highly frequent and enhanced injection site reaction induced by peripheral venous injection of fosaprepitant in anthracycline-treated patients. J Cancer 2014; 5:390-7. [PMID: 24799957 PMCID: PMC4007527 DOI: 10.7150/jca.7706] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [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] [Received: 09/19/2013] [Accepted: 02/26/2014] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Fosaprepitant-associated injection site reaction (ISR) has been reported in patients treated with cisplatin, an irritant drug. We conducted this retrospective study to clarify the incidence and symptoms of fosaprepitant-associated ISR in patients treated with anthracycline. PATIENTS AND METHODS Fifty six patients receiving 159 injections administering doxorubicin/cyclophosphamide (AC), fluorouracil/epirubicin/cyclophosphamide (FEC), or rituximab/cyclophosphamide/doxorubicin/vincristine/prednisolone (R-)CHOP regimen through a peripheral vein at ambulatory treatment centers reviewed for this study from patients' medical records. Incidence of ISR was compared between 24 patients with fosaprepitant injection (fosaprepitant group) and 32 patients without fosaprepitant (control group). Frequency and symptoms of ISR per injection were also compared between 61 injections with fosaprepitant and 98 injections without fosaprepitant. RESULTS Both the ISR incidence rate per patient and per injection were significantly higher in the fosaprepitant group than in the control group (67% vs. 16%; P=0.0002, 34% vs. 8.2%; P<0.0001, respectively). By multivariate analysis, fosaprepitant injection was found to be a significant independent variable correlated with ISR risk. Symptoms observed in 61 injections of fosaprepitant were pain (n=14, 23%), erythema (n=10, 16%), swelling (n=6, 10%), and delayed drip infusion (n=6, 10%). After the observation period, no ISR occurred when the administration route was changed to central venous injection or oral aprepitant was administered despite the continuation of chemotherapy. CONCLUSION ISR occurred more frequently and severely when fosaprepitant was injected through the peripheral vein in patients treated with anthracyclines compared to those without fosaprepitant.
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Affiliation(s)
- Yumiko Sato
- 1. Department of Pharmacy, Nagoya City West Medical Center
| | - Masahiro Kondo
- 2. Department of Pharmacy, Nagoya City University Hospital
| | - Atsushi Inagaki
- 3. Department of Hematology and Oncology, Nagoya City West Medical Center
| | | | - Chika Okada
- 5. Nursing department, Nagoya City West Medical Center
| | - Kumi Naruse
- 6. Nursing department, Nagoya City University Hospital
| | | | - Junko Kuroda
- 2. Department of Pharmacy, Nagoya City University Hospital
| | - Hiroka Ogura
- 3. Department of Hematology and Oncology, Nagoya City West Medical Center
| | - Shiori Uegaki
- 4. Division of Oncology, Nagoya City University Hospital
| | | | - Yoshinori Mori
- 4. Division of Oncology, Nagoya City University Hospital
| | - Hiroo Sawada
- 7. Department of Dermatology, Nagoya City West Medical Center
| | - Shoichi Watanabe
- 8. Department of Geriatric and Environmental Dermatology, Nagoya City University Graduate School of Medical Sciences
| | - Hiroshi Sugiura
- 9. Department of Breast and Endocrine Surgery, Nagoya City West Medical Center
| | - Yumi Endo
- 10. Department of Oncology, Immunology and Surgery, Nagoya City University Graduate School of Medical Sciences
| | - Nobuyasu Yoshimoto
- 10. Department of Oncology, Immunology and Surgery, Nagoya City University Graduate School of Medical Sciences
| | - Tatsuya Toyama
- 10. Department of Oncology, Immunology and Surgery, Nagoya City University Graduate School of Medical Sciences
| | - Shinsuke Iida
- 11. Department of Medical Oncology and Immunology, Nagoya City University Graduate School of Medical Sciences
| | - Koichi Yamada
- 1. Department of Pharmacy, Nagoya City West Medical Center
| | | | - Atsushi Wakita
- 3. Department of Hematology and Oncology, Nagoya City West Medical Center
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Azuma J, Fukase H. Pharmacokinetics of a Single 150-mg Intravenous Infusion of Fosaprepitant: Effects of Concentration and Infusion Time in Healthy Japanese Men. Clin Pharmacol Drug Dev 2013; 2:394-9. [PMID: 27121944 DOI: 10.1002/cpdd.58] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2012] [Accepted: 07/26/2013] [Indexed: 11/12/2022]
Abstract
PURPOSE Fosaprepitant dimeglumine (Proemend® for Injection; formerly ONO-7847) is a phosphorylated prodrug that is rapidly converted to aprepitant, an oral selective neurokinin-1 receptor antagonist approved for the prevention of chemotherapy-induced nausea and vomiting. This Phase 1 study evaluated the pharmacokinetics, safety, and tolerability of fosaprepitant after a single intravenous dose in healthy Japanese men. METHODS All fosaprepitant- or placebo-treated subjects were assessed for the occurrence of adverse events. RESULTS Ninety subjects were randomized into treatment and placebo groups. The plasma fosaprepitant concentrations generally reached steady state by 15 minutes after the start of infusion. Although the maximum concentration was proportional to the infusion time, no clinically important pharmacokinetic differences were noted in the cohorts examined. Most adverse events observed in this study were associated with infusion site reactions, which tended toward a higher incidence with shorter infusion times. These events were mild in severity. CONCLUSIONS These findings demonstrate that fosaprepitant at different concentrations and over different infusion times has a pharmacokinetic and safety profile that is comparable to the intravenous dose previously established as efficacious and well tolerated. The dosing flexibility afforded by the single-dose fosaprepitant formulation should lead to greater convenience for patients and health care providers.
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Affiliation(s)
- Junichi Azuma
- Department of Pharmacy, School of Pharmacy, Hyogo University of Health Sciences, Kobe, Hyogo, Japan
| | - Hiroyuki Fukase
- CPC Clinical Trial Hospital, Medical Research Institute, Kagoshima, Japan
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Celio L, Ricchini F, De Braud F. Safety, efficacy, and patient acceptability of single-dose fosaprepitant regimen for the prevention of chemotherapy-induced nausea and vomiting. Patient Prefer Adherence 2013; 7:391-400. [PMID: 23687442 PMCID: PMC3653760 DOI: 10.2147/ppa.s31288] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Control of chemotherapy-induced nausea and vomiting (CINV) is a crucial factor in ensuring that patients undergoing cancer chemotherapy can get the full benefit of therapy. Current antiemetic guidelines recommend that the neurokinin-1 receptor (NK-1R) antagonist aprepitant should be used as part of a combination regimen with dexamethasone and a serotonin receptor antagonist for the prevention of CINV in patients receiving highly emetogenic chemotherapy (HEC). Fosaprepitant is a water-soluble N-phosphoryl derivative of aprepitant that, when infused, is rapidly metabolized back to an active aprepitant. The existing literature in PubMed about fosaprepitant was screened and selected in order to address the emerging data from two randomized clinical trials evaluating the efficacy and safety of a single-dose fosaprepitant regimen. These phase III trials demonstrated that fosaprepitant given as a single intravenous dose of 150 mg was either noninferior to the conventional 3-day aprepitant or significantly superior to placebo for the prevention of acute and delayed CINV in patients receiving high-dose cisplatin. In both trials, fosaprepitant was well tolerated although more frequent infusion-site adverse events were observed with fosaprepitant. The new dosage regimen of fosaprepitant, therefore, would be an option for CINV control in patients receiving cisplatin-based chemotherapy. The clinical efficacy is consistent with the findings from a time-on-target, positron-emission tomography study evaluating the NK-1R occupancy in the central nervous system (CNS) over 5 days after a single-dose infusion of 150 mg fosaprepitant in healthy participants. The single-dose regimen is capable of blocking more than 90% of the NK-1Rs in the CNS for at least 48 hours after infusion, which is sufficient to control delayed CINV for 2 to 5 days after HEC. The new dosage regimen of fosaprepitant can provide a simplified treatment option that maintains high protection while ensuring adherence to scheduled antiemetic medication throughout most of the 5-day period encompassing the major risk for CINV.
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Affiliation(s)
- Luigi Celio
- Correspondence: Luigi Celio, Medical Oncology Unit 1, Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale Tumori, Via G Venezian 1, 20133 Milan, Italy, Tel +39 2 2390 2597, Fax +39 2 2390 2149, Email
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Upadhyay J, Anderson J, Schwarz AJ, Coimbra A, Baumgartner R, Pendse G, George E, Nutile L, Wallin D, Bishop J, Neni S, Maier G, Iyengar S, Evelhoch JL, Bleakman D, Hargreaves R, Becerra L, Borsook D. Imaging drugs with and without clinical analgesic efficacy. Neuropsychopharmacology 2011; 36:2659-73. [PMID: 21849979 DOI: 10.1038/npp.2011.156] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The behavioral response to pain is driven by sensory and affective components, each of which is mediated by the CNS. Subjective pain ratings are used as readouts when appraising potential analgesics; however, pain ratings alone cannot enable a characterization of CNS pain circuitry during pain processing or how this circuitry is modulated pharmacologically. Having a more objective readout of potential analgesic effects may allow improved understanding and detection of pharmacological efficacy for pain. The pharmacological/functional magnetic resonance imaging (phMRI/fMRI) methodology can be used to objectively evaluate drug action on the CNS. In this context, we aimed to evaluate two drugs that had been developed as analgesics: one that is efficacious for pain (buprenorphine (BUP)) and one that failed as an analgesic in clinical trials aprepitant (APREP). Using phMRI, we observed that activation induced solely by BUP was present in regions with μ-opioid receptors, whereas APREP-induced activation was seen in regions expressing NK(1) receptors. However, significant pharmacological modulation of functional connectivity in pain-processing pathways was only observed following BUP administration. By implementing an evoked pain fMRI paradigm, these drugs could also be differentiated by comparing the respective fMRI signals in CNS circuits mediating sensory and affective components of pain. We report a correlation of functional connectivity and evoked pain fMRI measures with pain ratings as well as peak drug concentration. This investigation demonstrates how CNS-acting drugs can be compared, and how the phMRI/fMRI methodology may be used with conventional measures to better evaluate candidate analgesics in small subject cohorts.
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Abstract
Fosaprepitant is a prodrug of aprepitant, a neurokinin1 (NK1) receptor antagonist used in prophylactic antiemetic regimens used prior to cytotoxic chemotherapy. Fosaprepitant is being developed to provide a parenterally administered alternative to the orally administered aprepitant. Fosaprepitant is rapidly converted to aprepitant and an intravenous dose of 115 mg is bioequivalent to 125 mg orally, with similar plasma concentrations at 24 hours. In phase I and II trials fosaprepitant shows efficacy, but the large randomized efficacy studies have utilized aprepitant. When it is added to dexamethasone and a 5HT3 receptor antagonist on day 1 prior to chemotherapy aprepitant improves the control of acute post chemotherapy emesis and when continued on days 2 and 3 with dexamethasone it demonstrated even greater improvement in the control of delayed emesis. This has been shown with both cisplatin-containing regimens and those based upon cyclophosphamide and an anthracycline. Fosaprepitant is well tolerated with mild to moderate venous irritation being the only additional toxicity to those seen with oral aprepitant, and that is a function of dose, concentration, and infusion rate. Headaches are the other toxicity most commonly reported. Fosaprepitant can be used as a parenteral alternative to aprepitant in regimens to control chemotherapy-induced emesis.
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Affiliation(s)
- Ian N Olver
- The Cancer Council Australia Sydney, New South Wales, Australia
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Langford P, Chrisp P. Fosaprepitant and aprepitant: an update of the evidence for their place in the prevention of chemotherapy-induced nausea and vomiting. Core Evid 2010; 5:77-90. [PMID: 21042544 PMCID: PMC2963924 DOI: 10.2147/ce.s6012] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/24/2009] [Indexed: 11/23/2022]
Abstract
INTRODUCTION The selective neurokinin-1 receptor antagonist aprepitant is effective in the treatment of acute and delayed chemotherapy-induced nausea and vomiting (CINV) associated with both moderately and highly emetogenic chemotherapy. Fosaprepitant has been developed as an intravenous prodrug of aprepitant. AIMS To update the evidence underlying the use of fosaprepitant to prevent CINV. EVIDENCE REVIEW Aprepitant in combination with a serotonin antagonist and a corticosteroid controls acute and delayed symptoms of CINV in patients receiving moderately to highly emetogenic chemotherapy. Bioequivalence of fosaprepitant with aprepitant has recently been demonstrated, which has led to its inclusion in clinical guidelines for treatment of acute CINV with highly, and some regimens of moderately, emetogenic chemotherapy. Early studies of the clinical efficacy of fosaprepitant have shown improvement over treatment with ondansetron. Both aprepitant and fosaprepitant are well tolerated with most adverse events observed of mild or moderate intensity. Conflicting economic evidence has shown that whilst aprepitant provides an increased quality of life in patients treated for CINV, there are differing views over its absolute cost in relation to standard therapy. The incremental cost-effectiveness ratio of aprepitant, however, appears to lie within acceptable bounds. PLACE IN THERAPY Fosaprepitant and aprepitant are recommended in guidelines for preventing CINV due to moderately and highly emetogenic chemotherapy. Fosaprepitant is bioequivalent to aprepitant, and could offer potential benefits for patients who may be unable to tolerate oral administration of antiemetics during an episode of nausea or vomiting.
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Affiliation(s)
| | - Paul Chrisp
- Core Medical Publishing, Knutsford, UK; These affiliations were correct at the time the manuscript was prepared
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Abstract
IMPORTANCE OF THE FIELD Chemotherapy induced nausea and vomiting (CINV) is a common complication in the treatment of patients with cancer. The introduction of the first in class neurokinin-1 receptor antagonist aprepitant provided additive control on CINV in combination to existing antiemetics. Due to formulation issues, aprepitant is only available for oral administration. Fosaprepitant, a prodrug of aprepitant, was introduced to the market in 2008 as an intravenous bioequivalent to aprepitant. AREAS COVERED IN THIS REVIEW This review examines the chemical development of fosaprepitant, its pharmacokinetic properties, approved uses and potential applications. WHAT THE READER WILL GAIN The reader will get up-to-date information on the pharmacology and clinical uses of fosaprepitant. Clinical studies have demonstrated pharmacokinetic bioequivalence of aprepitant 125 mg to fosaprepitant 115 mg, as well as comparable efficacy in prevention of acute and delayed emesis following the first day of chemotherapy regimens. TAKE HOME MESSAGE Fosaprepitant is an intravenous prodrug of aprepitant that offers a new alternative to patients with CINV. Currently, fosaprepitant can substitute oral aprepitant in day 1 of a 3-day regimen. Current studies show that a single-day fosaprepitant regimen is also bioequivalent to the 3-day aprepitant regimen; this could significantly simplify the care for CINV patients in the future.
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Affiliation(s)
- Francheska Colon-Gonzalez
- Thomas Jefferson University, Department of Pharmacology and Experimental Therapeutics, 1170 Main Building, 132 S. 10th St., Philadelphia, PA 19107, USA
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