Satisfaction of Patients Treated with Platinum Derivatives with Antiemetic Therapy

Managing Chemotherapy-Induced Nausea

Chemotherapy-induced nausea and vomiting (CINV) is a well-known complication of certain chemotherapy regimens. Highly emetogenic treatments include, for example, therapies with cisplatin derivatives. The first and so far only oral fixed combination treatment approved for CINV is NEPA – a combination of the NK₁ receptor antagonist netupitant with the 5-HT₃ receptor antagonist palonosetron.

Study Methodology

The primary aim of the ongoing prospective AkyPRO study is to evaluate the quality of life of 2500 patients using NEPA for the prevention of CINV during three cycles of chemotherapy with medium or high emetogenic potential. The quality of life is assessed by the patients themselves using the FLIE questionnaire (Functional Living Index – Emesis).

The secondary aims of the study include determining the effectiveness of the antiemetic treatment as assessed by patients and their attending physicians using a 4-point scale, the need for rescue antiemetic therapy, and the safety of the treatment.

Results

An interim analysis of data from 595 patients treated with platinum derivatives showed that chemotherapy-induced vomiting can be managed very effectively in most of them. 80–90% of participants reported no impact of vomiting on their quality of daily life. 84–90% achieved complete response (no vomiting, no need for rescue medication) during the three analyzed treatment cycles, regardless of the type of platinum derivative used.

Most patients also did not experience nausea or felt only mild nausea during the first cycle of chemotherapy – this included 74% of patients treated with cisplatin, 81% with carboplatin, and 68% with oxaliplatin. However, mild nausea seemed to significantly impact the quality of life (40% of patients on cis- or carboplatin and 46% on oxaliplatin reported a negative impact of nausea on their daily activities).

Conclusion

Antiemetic treatment with NEPA was able to very effectively control both vomiting and nausea during three cycles of chemotherapy, regardless of the type of administered platinum derivative. Although oxaliplatin is classified as having moderate emetogenic potential, managing nausea was more challenging compared to the highly emetogenic cis- or carboplatin.

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Source: Karthaus M., Heilmann V., Klausmann M., et al. Patient-reported outcome data during real-world use of NEPA for prevention of chemotherapy-induced nausea and vomiting in high-risk platinum-receiving patients: a prospective multicenter trial. Ann Oncol 2019; 30 (suppl. 5): 1767P [abstract].