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19.10.2018 | Original Article

A phase II open-label study of aprepitant as anti-emetic prophylaxis in patients with acute myeloid leukemia (AML) undergoing induction chemotherapy

Zeitschrift:
Supportive Care in Cancer
Autoren:
Joseph M. Brandwein, Jack T. Seki, Eshetu G. Atenafu, Amr Rostom, Andrzej Lutynski, Anna Rydlewski, Aaron D. Schimmer, Andre C. Schuh, Vikas Gupta, Karen W. L. Yee

Abstract

Despite the widespread use of 5-HT3 antagonists as anti-emetic prophylaxis in patients with acute myeloid leukemia (AML) receiving induction chemotherapy, nausea and vomiting persist in many cases. We performed a Phase II single-arm study evaluating the use of aprepitant on days 1–5, in combination with a 5-HT antagonist on days 1–3, in AML patients undergoing induction chemotherapy with daunorubicin on days 1–3 plus cytarabine, given as a continuous infusion, on days 1–7. This was compared to a retrospective cohort of AML patients that received the same chemotherapy regimen with a 5-HT antagonist but without aprepitant. The cumulative incidence of vomiting/retching by the end of day 5 was significantly lower in the aprepitant vs. the control group (26.3 vs. 52.8%, p = 0.013). The cumulative incidence of nausea by the end of day 5 was 61% in the aprepitant group vs. 75% in the control group. The total use of supplemental anti-emetics on days 2–5 was also significantly lower in the aprepitant group (p = 0.01). In contrast, the cumulative incidence of vomiting/retching by the end of day 8, the incidence of vomiting/retching on days 6–8, and the use of anti-emetics on days 6–8, were not significantly different between the two groups. The results suggest that the use of aprepitant may be associated with a lower rate of emesis during aprepitant dosing days, but not afterward. However, this requires confirmation in a randomized trial.

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