Identification of optimal contemporary antiemetic prophylaxis for doxorubicin-cyclophosphamide chemotherapy in Chinese cancer patients: post-hoc analysis of 3 prospective studies

摘要

Objective:Chemotherapy-induced nausea and vomiting(CINV)are common with doxorubicin-cyclophosphamide(AC)chemotherapy.Recommended antiemetic regimens incorporate neurokinin-1 receptor antagonist(NK1 RA),5-hydroxytryptamine type-3 receptor antagonist(5 HT3 RA),corticosteroid,and dopamine antagonists.This post-hoc analysis compared results of 3 prospective antiemetic studies conducted among Chinese breast cancer patients who received(neo)adjuvant AC,in order to identify optimal antiemetic prophylaxis.Methods:A total of 304 patients were included:Group 1,ondansetron/dexamethasone(D1);Group 2,aprepitant/ondansetron/dexamethasone(D1);Group 3,aprepitant/ondansetron/dexamethasone(D1–3);Group 4,aprepitant/ondansetron/dexamethasone(D1–3)/olanzapine;and Group 5,netupitant/palonosetron/dexamethasone(D1–3).Antiemetic efficacies of Groups 3,4,and 5 during cycle 1 of AC were individually compared with Group 1.In addition,emesis outcomes of patients in Groups 3 and 5,and those of Groups 2 and 3,were compared.Results:When comparing efficacies of a historical doublet(5 HT3 RA/dexamethasone)with triplet antiemetic regimens(NK1 RA/5 HT3 RA/dexamethasone)with/without olanzapine,complete response(CR)percentages and quality of life(QOL)in overall phase of cycle 1 AC were compared between Group 1 and the other groups:Group 1 vs.3,41.9%vs.38.3%(P=0.6849);Group 1 vs.4,41.9%vs.65.0%(P=0.0107);and Group 1 vs.5,41.9%vs.60.0%(P=0.0460).Groups 4 and 5 achieved a better QOL.When comparing netupitant-based(Group 3)with aprepitant-based(Group 5)triplet antiemetics,CR percentages were 38.3%vs.60.0%,respectively(P=0.0176);Group 5 achieved a better QOL.When comparing 1 day(Group 2)vs.3 day(Group 3)dexamethasone,CR percentages were 46.8%and 38.3%,respectively(P=0.3459);Group 3 had a worse QOL.Conclusions:Aprepitant-containing triplets were non-superior to doublet antiemetics.Netupitant-containing triplets and adding olanzapine to aprepitant-containing triplets were superior to doublets.Netupitant/palonosetron/dexamethasone was superior to aprepitant/ondansetron/dexamethasone.Protracted administration of dexamethasone provided limited additional benefit.