Effects of adding a neurokinin-1 receptor antagonist to 5 mg olanzapine, a 5-hydroxytryptamine-3 receptor antagonist, and dexamethasone for preventing carboplatin-induced nausea and vomiting: a propensity score-matched analysis
Senri Yamamoto,
Hirotoshi Iihara,
Ryuji Uozumi,
Hitoshi Kawazoe,
Kazuki Tanaka,
Yukiyoshi Fujita,
Masakazu Abe,
Hisao Imai,
Masato Karayama,
Yoh Hayasaki,
Chiemi Hirose,
Takafumi Suda,
Kazuto Nakamura,
Akio Suzuki,
Yasushi Ohno,
Ken-ichirou Morishige,
Naoki Inui
Affiliations
Senri Yamamoto
Department of Pharmacy, Gifu University Hospital
Hirotoshi Iihara
Department of Pharmacy, Gifu University Hospital
Ryuji Uozumi
Department of Biomedical Statistics and Bioinformatics, Kyoto University Graduate School of Medicine
Hitoshi Kawazoe
Division of Pharmaceutical Care Sciences, Center for Social Pharmacy and Pharmaceutical Care Sciences, Keio University Faculty of Pharmacy
Kazuki Tanaka
Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine
Yukiyoshi Fujita
Division of Pharmacy, Gunma Prefectural Cancer Center
Masakazu Abe
Division of Gynecology, Shizuoka Cancer Center
Hisao Imai
Division of Respiratory Medicine, Gunma Prefectural Cancer Center
Masato Karayama
Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine
Yoh Hayasaki
Department of Obstetrics and Gynecology, Gifu University Graduate School of Medicine
Chiemi Hirose
Department of Pharmacy, Gifu University Hospital
Takafumi Suda
Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine
Kazuto Nakamura
Department of Gynecology, Gunma Prefectural Cancer Center
Akio Suzuki
Department of Pharmacy, Gifu University Hospital
Yasushi Ohno
Department of Cardiology and Respiratory Medicine, Gifu University Graduate School of Medicine
Ken-ichirou Morishige
Department of Obstetrics and Gynecology, Gifu University Graduate School of Medicine
Naoki Inui
Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine
Abstract Background Olanzapine has been reported to be an effective antiemetic in patients receiving carboplatin-based chemotherapy. However, the efficacy of a neurokinin-1 receptor antagonist (NK1RA) added to olanzapine, a 5-hydroxytryptamine-3 receptor antagonist (5-HT3RA), and dexamethasone (DEX) has not been proven. This study aimed to assess the efficacy and safety of NK1RA, in combination with three-drug antiemetic regimens containing olanzapine, in preventing nausea and vomiting induced by carboplatin-based chemotherapy. Methods Data were pooled for 140 patients receiving carboplatin-based chemotherapy from three multicenter, prospective, single-arm, open-label phase II studies that evaluated the efficacy and safety of olanzapine for chemotherapy-induced nausea and vomiting. The propensity score of the co-administration of NK1RA was estimated for each patient using a logistic regression model that included age, sex, and carboplatin dose. We analyzed a total of 62 patients, who were treated without NK1RA (non-NK1RA group: 31 patients) and with NK1RA (NK1RA group: 31 patients). The patients were selected using propensity score matching. Results The complete response rate (without emetic episodes or with no administration of rescue medication) in the overall period (0–120 h post carboplatin administration) was 93.5% in the non-NK1RA group and 96.8% in the NK1RA group, with a difference of -3.2% (95% confidence interval, -18.7% to 10.9%; P = 1.000). In terms of safety, there was no significant difference between the groups in daytime sleepiness and concentration impairment, which are the most worrisome adverse events induced by olanzapine. Conclusions The findings suggest that antiemetic regimens consisting of olanzapine, 5HT3RA, and DEX without NK1RA may be a treatment option for patients receiving carboplatin-based chemotherapy.
