Frontiers in Oncology (Aug 2022)

Primary versus secondary antiemetic prophylaxis with NK1 receptor antagonists in patients affected by gastrointestinal malignancies and treated with a doublet or triplet combination regimen including oxaliplatin and/or irinotecan plus fluoropyrimidines: A propensity score matched analysis

  • Alessandro Parisi,
  • Alessandro Parisi,
  • Riccardo Giampieri,
  • Alex Mammarella,
  • Cristiano Felicetti,
  • Lisa Salvatore,
  • Lisa Salvatore,
  • Maria Bensi,
  • Maria Bensi,
  • Maria Grazia Maratta,
  • Maria Grazia Maratta,
  • Antonia Strippoli,
  • Roberto Filippi,
  • Roberto Filippi,
  • Maria Antonietta Satolli,
  • Maria Antonietta Satolli,
  • Angelica Petrillo,
  • Bruno Daniele,
  • Michele De Tursi,
  • Michele De Tursi,
  • Pietro Di Marino,
  • Pietro Di Marino,
  • Guido Giordano,
  • Matteo Landriscina,
  • Pasquale Vitale,
  • Ina Valeria Zurlo,
  • Emanuela Dell’Aquila,
  • Silverio Tomao,
  • Ilaria Depetris,
  • Francesca Romana Di Pietro,
  • Federica Zoratto,
  • Davide Ciardiello,
  • Davide Ciardiello,
  • Maria Vittoria Pensieri,
  • Ornella Garrone,
  • Barbara Galassi,
  • Claudio Ferri,
  • Rossana Berardi,
  • Michele Ghidini

DOI
https://doi.org/10.3389/fonc.2022.935826
Journal volume & issue
Vol. 12

Abstract

Read online

AimThe aim of the current study is to investigate the impact of primary compared to secondary chemotherapy-induced nausea and vomiting (CINV) prophylaxis with NK1 receptor antagonists (NK1-RA) in patients affected by gastrointestinal malignancies and treated with oxaliplatin- and/or irinotecan-based doublet or triplet regimens.Study design and methodsClinical data of patients affected by gastrointestinal malignancies, treated with an oxaliplatin and/or irinotecan-based doublet or triplet regimen as neo/adjuvant or advanced-line treatment, and who received NK1-RA as primary (from the first cycle of treatment) or secondary (after the onset of CINV with a previous regimen with 5HT3-RA and dexamethasone) prophylaxis for CINV, were retrospectively collected in an observational study involving 16 Italian centers. A propensity score matching was performed by taking into account the following stratification factors: sex (male vs. female), age (< vs. ≥70 years old), overweight (body mass index, BMI < vs. ≥25), underweight (BMI < vs. ≥19), disease spread (early vs. advanced/metastatic), tumor type (esophagogastric cancer vs. the rest, hepatobiliary tumor vs. the rest, colorectal cancer vs. the rest), type of NK1-RA used as primary/secondary prophylaxis (netupitant-palonosetron vs. fosaprepitant/aprepitant), concomitant use of opioids (yes vs. no), concomitant use of antidepressant/antipsychotic drugs (yes vs. no), Eastern Cooperative Oncology Group (ECOG) performance status at the start of NK1-RA treatment (0 vs. 1–2), and intensity of chemotherapy regimen (doublet vs. triplet).ResultsAmong 409 patients included from January 2015 to January 2022 and eligible for analysis, 284 (69%) and 125 (31%) were treated with NK1-RA as primary and secondary antiemetic prophylaxis, respectively. After matching, primary NK1-RA use was not associated with higher rates of protection from emesis regardless the emesis phase (acute phase, p = 0.34; delayed phase, p = 0.14; overall phase, p = 0.80). On the other hand, a lower rate of relevant nausea (p = 0.02) and need for rescue antiemetic therapy (p = 0.000007) in the overall phase was found in primary NK1-RA users. Furthermore, a higher rate of both complete antiemetic response (p = 0.00001) and complete antiemetic protection (p = 0.00007) in the overall phase was more frequently observed in primary NK1-RA users. Finally, chemotherapy delays (p = 0.000009) and chemotherapy dose reductions (p = 0.0000006) were less frequently observed in primary NK1-RA users.ConclusionIn patients affected by gastrointestinal malignancies, a primary CINV prophylaxis with NK1-RA, 5HT3-RA, and dexamethasone might be appropriate, particularly in those situations at higher risk of emesis and in which it is important to avoid dose delays and/or dose reductions, keeping a proper dose intensity of chemotherapy drugs.

Keywords