Efficacy of 3-day versus 5-day aprepitant regimens for long-delayed chemotherapy-induced nausea and vomiting in patients receiving cisplatin-based chemotherapy

Chemotherapy-induced nausea and vomiting (CINV) is an ongoing problem. While effectiveness of triplet antiemetic regimens in the delayed CINV phase (24–120 hours after administration of chemotherapy) has been studied, their effectiveness in the long-delayed phase (120–168 hours post-administration) is unknown. We compared the efficacy of 3- and 5-day courses of a triplet antiemetic prophylaxis containing aprepitant (APR) in controlling long-delayed CINV after cisplatin (CDDP)-based chemotherapy.
We obtained patient-level data from a nationwide, multicenter, prospective observational study in Japan. The incidence and timing of CINV after 3- and 5-day APR-containing regimens were compared using inverse probability treatment weighting.
The analysis included 380 patients. The incidence rates of long-delayed nausea and vomiting were significantly reduced for the 5-day compared with the 3-day regimen (29.1% vs. 22.2%, p = 0.0042; 6.7% vs. 0%, p < 0.0001, respectively). Among those without CINV, vomiting was not reported after day 2 in the 5-day APR group but increased after day 4 in the 3-day APR group.
A 5-day regimen triplet antiemetic prophylaxis with APR decreased long-delayed vomiting compared with a 3-day regimen in patients receiving CDDP-based chemotherapy. However, the 5-day regimen showed no advantage over the 3-day regimen against long-delayed nausea.

化疗诱导的恶心呕吐（Chemotherapy-induced nausea and vomiting, CINV）仍是临床持续存在的问题。尽管三联止吐方案（triplet antiemetic regimens）在迟发性CINV期（化疗给药后24~120小时）的疗效已得到研究，但该方案在极迟发性CINV期（给药后120~168小时）的疗效仍不明确。本研究对比了含阿瑞匹坦（aprepitant, APR）的三联止吐预防方案采用3天与5天疗程时，针对顺铂（cisplatin, CDDP）基化疗后极迟发性CINV的控制效果。
我们从日本一项全国多中心前瞻性观察研究中获取了患者个体水平数据，采用逆概率治疗加权（inverse probability treatment weighting）法对比了含APR的3天与5天疗程方案给药后CINV的发生率与发作时机。
本分析共纳入380例患者。相较于3天疗程方案，5天疗程方案的极迟发性恶心与呕吐发生率均显著降低（恶心发生率：29.1% vs 22.2%，p=0.0042；呕吐发生率：6.7% vs 0%，p<0.0001）。在未发生CINV的患者中，5天APR组在第2天后未再报告呕吐事件，而3天APR组的呕吐事件在第4天后有所增加。
相较于3天疗程方案，含APR的5天疗程三联止吐预防方案可降低接受CDDP基化疗患者的极迟发性呕吐发生率，但在极迟发性恶心的控制上，5天疗程并未展现出优于3天疗程的优势。