Recent Research in Antiemetics

Recent Research in Antiemetics

March 2018
Stay informed with six new studies in antiemetics research by MASCC members.

Genetic Polymorphisms and CINV
MASCC members Kord Kober and Christine Miaskowski participated in this literature review to examine associations between the occurrence and severity of CINV and polymorphisms in serotonin receptor, drug metabolism, and drug transport pathway genes. The authors summarize the findings of 16 studies that evaluate the associations between CINV variables and single nucleotide polymorphisms. Given the small number of polymorphisms studied so far, there remains a need to identify mechanisms to allow for developing more targeted therapies. The authors identify limitations of current knowledge and directions for research. (Singh KP, Dhruva AA, Flowers E, Kober KM, Miaskowski C. Crit Rev Oncol Hematol. 2018 Jan;121:51-61.)

Olanzapine to Prevent Emesis Caused by Cisplatin or Ifosfamide
Kazuo Tamura and his colleagues at the National Cancer Center Hospital in Tokyo conducted this prospective dose-escalation study to determine the feasibility and efficacy of olanzapine for prevention of CINV in patients undergoing continuous five-day chemotherapy. A 2.5 mg/day dose of olanzapine was found to prevent CINV in these patients. None experienced dose-limiting toxicity and none had a vomiting episode. A dose of 10 mg/day (recommended by international CINV guidelines) is also tolerated. If CINV is not controlled by an initial dose of 2.5 mg/day of olanzapine, dosage escalation is encouraged. (Bun S, Yonemori K, Akagi T et al. Invest New Drugs. 2018 Feb;36(1):151-155.)

NK1 Receptor Antagonists for CINV in Moderately Emetogenic Chemotherapy
Karin Jordan and her colleagues at Martin Luther University (Halle, Germany) and University Hospital Heidelberg recently reported the results of a systematic review and meta-analysis to evaluate the efficacy of neurokinin-1 receptor antagonists (NK1RAs) for preventing CINV in moderately emetogenic chemotherapy (MEC), excluding anthracycline-cyclophosphamide- based regimens. The results indicate that the addition of NK1RAs results clinically significant benefits in carboplatin-based chemotherapy. More research is needed to determine the global benefit of an NK1RA-containing regimen for the whole MEC category. (Jordan K, Blättermann L, Hinke A et al. Support Care Cancer. 2018 Jan;26(1):21-32.)

Single-Dose NEPA Versus an Aprepitant Regimen to Prevent CINV
Li Zhang, with MASCC members Matti Aapro and Karin Jordan and other colleagues, conducted the first head-to-head comparison of NEPA with an aprepitant (APR)/granisetron (GRAN) regimen for preventing CINV in patients receiving highly emetogenic chemotherapy. A single oral dose of NEPA proved comparable to a 3-day regimen of APR/GRAN for compete response, no emesis, and no significant nausea, and significantly fewer NEPA patients required rescue medication. NEPA was well tolerated and had a safety profile similar to that of APR/GRAN. (Zhang L, Lu S, Feng J, Dechaphunkul A, et al. Ann Oncol. 2018 Feb 1;29(2):452-458.)

Fosaprepitant for Prevention of CINV
MASCC members Bernardo Rapoport and Karin Jordan, along with Cindy Weinstein, report on a recent Phase III trial that prospectively evaluated fosaprepitant-based antiemetic therapy for CINV prevention in a large, well-defined nonanthracycline- and cyclophosphamide-based, moderately emetogenic chemotherapy population. Compared with a control regimen, fosaprepitant demonstrated significantly greater efficacy outcomes and was generally well tolerated. The results indicate that NK1 receptor antagonists are a valuable therapeutic option in this setting. (Rapoport BL, Jordan K, Weinstein C. Future Oncol. 2018 Jan; 14(1):77-92.)

Amisulpride to Prevent CINV in Cisplatin-Based Therapy
Jørn Herrstedt and colleagues investigated the antiemetic effect of the amisulpride, a dopamine D2- and D3-receptor antagonist, in patients receiving cisplatin-based chemotherapy. This dose-escalation study showed that amisulpride has a marked antiemetic effect against acute cisplatin-induced vomiting, and especially nausea. The study is a first step toward further investigation of amisulpride in CINV via randomized trials. (Herrstedt J, Summers Y, Daugaard G, et al. Support Care Cancer. 2018 Jan; 26(1):139-145.)