Süleyman TEMİZ, Kazım UYGUN, Görkem AKSU, Fatih ENSAROĞLU, İlhan DOLAŞIK, Selçuk Y. ŞENER, Faden H. AYDIN, Doğu CANOĞLU

Evaluation of the efficacy of aprepitant on the prevention of chemotherapy-ınduced nausea and vomiting and quality of life with functional living ındex emesis

Objective: Functional Living Index Emesis (FLIE) is developed to evaluate the relationship between emesis and it s effects on patient s daily life and is far more relevant to detect the effectiveness of antiemetic treatment compared with self-diary reports. In this study, the efficacy of oral neurokinin-1 antagonist aprepitant on the prevention of chemotherapy-induced nausea and vomiting and quality of life is evaluated with FLIE. Study Design: Cross sectional study. Material and Methods: Sixty patients with Non-Small Cell Lung Cancer (NSCLC) receiving a chemotherapy regimen consisting of Cisplatin and Docetax- el were evaluated. The patients were prospectively randomized to two groups before the first cycle of chemotherapy. Patients in Group A (31 patients) received 3 daily doses of aprepitant along with oral ondansetron and dexamethasone. The patients in group B (29 patients) received only ondansetron and dexamathasone. The efficacy of both regimens was evaluated by a modified Turkish version of FLIE scale consisting of 18 questions. Results: The number of patients with complete response was 31 in the whole group. Of these 18 patients (58%) were in Group A (Aprepitant) and 13 patients in group B (42%). Median FLIE score in group A was 24.97 (±12.45) while it was 38.1 (±26.987) in group B and the difference was statistically significant (p=0.022). Total score >20 was seen in only 5 of 31 patients in aprepitant group (16%) showing the significant efficiency of aprepitant on quality of life, while in group B, 13 of 29 patients (44%) had total scores >20 (p=0.02). Conclusion: Regarding these findings, it is certain to state that aprepitant in combination with other drugs optimizes protection against both nausea and vomiting compared to the prior standard of care, and must be recommended as first-line therapy for patients who are treated with moderately or highly emetogenic chemotherapy.

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1.Richardson JL, Marks G, Levine A. The influence of symptoms of disease and side effects of treatment on compliance with cancer therapy. J Clin Oncol 1988;5:1746-52.
2.Lazslo J. Emesis as limiting toxicity in cancer chemotherapy. In Lazslo J, ed. Antiemetics and cancer chemotherapy. Baltimore, Maryland:Williams & Wilkins 1983:1-5.
3.Borison HL, Wang S. Physiology and pharmacology of vomiting. Pharmacol Rev 1953;5:193-230.
4.Siegel LJ, Longo DL. The control of chemotherapy induced em- esis. Ann Intern Med 1981;95:352-9.
5. Hesketh PJ, Grunberg SM, Gralla RJ, Warr DG, Roila F, de Wit R, et al. The oral neurokinin-1 antagonist aprepitant for the preven- tion of chemotherapy-induced nausea and vomiting:a multina- tional, randomizedi double-blind, placebo-controlled trial in pa- tients receiving high-dose cisplatin-The Aprepitant Protocol 052 Study Group. J Clin Oncol 2003;21:4112-9. [CrossRef]
6.Warr DG, Eisenberg P, Hesketh PJ, et al. Effect of aprepitant for the prevention of nausea and vomiting after one cycle of mod- erately emetogenic chemotherapy:A randomized double-blind trial in 866 patients. ASCO annual meeting Proceedings (post- meeting edition). J Clin Oncol 2004;22:8007.
7.Decker GM, DeMeyer ES, Kisko DL. Measuring the maintenance of daily life activities using the functional living index-emesis (FLIE) in patients receiving moderately emetogenic chemother- apy. J Support Oncol 2006;4:35-52.
8.Martin AR, Carides AD, Pearson JD, Horgan K, Elmer M, Schmidt C, et al. Functional relevance of antiemetic control:experience us- ing the FLIE questionnaire in a randomized study of the NK-1 an- tagonist aprepitant. Eur J Cancer 2003;39:1395-401. [CrossRef]
9. de Wit R, Herrstedt J, Rapoport B, Carides AD, Guoguang-Ma J, Elmer M, et al. The oral NK(1) antagonist aprepitant, given with standart antiemetics provides protection against nausea and vomiting over multiple cycles of cisplatin-based chemotherapy:a combined analysis of two randomized, placebo controlled phase III clinical trials. Eur J Cancer 2004;40:403-10. [CrossRef]
10. Tremont-Lukats IW, Gonzalez-Barboteo J, Bruera E, et al. Meta- analysis of neurokinin-1 receptor antagonists (NK-1 RA) for chemotherapy-induced nausea and vomiting (CINV). ASCO An- nual Meeting Proceedings (post-meeting edition). J Clin Oncol 2004;22:8047.
11. Grote T, Hajdenberg J, Cartmell A, Ferguson S, Ginkel A, Charu V. Combination therapy for chemotherapy-induced nau- sea and vomiting in patients receiving moderately emetogenic chemotherapy:palonosetron, dexamethasone and aprepitant. J Support Oncol 2006;4:403-8.
12. Kris MG, Tonato M, Bria E, Ballatori E, Espersen B, Herrstedt J, et al. Consensus recommendations for the prevention of vomiting and nausea following high-emetic-risk chemotherapy. Support Care Cancer 2011;19 Suppl 1:S25-32. [CrossRef]