Efficacy and safety of aprepitant in combination with dexamethasone, granisetron and metoclopramide as a prophylaxis of chemotherapy induced nausea and vomiting in highly emetogenic chemotherapy.
Moustafa, Iman Moustafa Fetouh.
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This study was conducted to evaluate and compare the efficacy and safety of aprepitant in combination with dexamethasone, granisetron and metoclopramide (APR-DGM) versus a treatment regimen containing dexamethasone, granisetron and metoclopramide (DGM) as a prophylaxis in chemotherapy induced nausea and vomiting (CINV) in highly emetogenic chemotherapy in cancer patients. A retrospective study, conducted in King Abdul-Aziz Medical city (Eastern Region, Saudi Arabia). Three hundred and nine patients, treated with highly emetogenic chemotherapy, were enrolled in a retrospective, single-center cohort study. This study is a cross sectional study for the period 2010-2014. The primary efficacy endpoint was the complete response (CR) for acute emesis (during the 0–24-hrs. interval after chemotherapy). Secondary endpoint was the CR rates for delayed emesis (during the 24 hrs. -120 hrs. after chemotherapy). The APR-DGM regimen showed a significantly improved control in the management of CINV in patients treated with highly emetogenic chemotherapy in acute emesis compared to the DGM regimen (P= 0.0021). No significant difference was observed between the two regimens with regards to delayed emesis (P= 0.145). Both groups were tolerated well, and the rates of adverse events were not significantly different between groups. The addition of aprepitant to the standard regimen of dexamethasone, granisetron and metoclopramide was found to be significantly better than dexamethasone, granisetron and metoclopramide alone in the control of acute emesis, but with no significant change in delayed emesis. This study therefore supports the change of regimen in the management of acute emesis with highly emetogenic chemotherapy to include aprepitant.