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Poster display session

3210 - Efficacy of neurokinin-1 receptor antagonists in the prevention of Chemotherapy-Induced Nausea and Vomiting in patients receiving carboplatin-based chemotherapy: a systematic review and meta-analysis.


10 Sep 2017


Poster display session


Massimo Di Maio


Annals of Oncology (2017) 28 (suppl_5): v543-v567. 10.1093/annonc/mdx388


M. Di Maio1, C. Baratelli1, P. Bironzo2, F. Vignani1, E. Bria3, E. Sperti4, M. Marcato1, F. Roila5

Author affiliations

  • 1 Division Of Medical Oncology, "Ordine Mauriziano" Hospital, Department of Oncology, University of Turin, 10128 - Turin/IT
  • 2 Division Of Medical Oncology, Azienda Ospedaliera Universitaria San Luigi Gonzaga, Department of Oncology, University of Turin, 10043 - Orbassano/IT
  • 3 Medical Oncology, University of Verona, 37134 - Verona/IT
  • 4 Division Of Medical Oncology, "Ordine Mauriziano" Hospital, 10128 - Turin/IT
  • 5 Medical Oncology, Azienda Ospedaliera Sta Maria, 5100 - Terni/IT


Abstract 3210


According to current ESMO – MASCC guidelines, a combination of a neurokinin-1 receptor antagonist (NK1RA), dexamethasone and a 5-HT3 receptor antagonist (5-HT3RA) is recommended to prevent carboplatin-induced emesis, with moderate level of confidence and not unanimous consensus. Our aim was to perform a meta-analysis of all randomized trials (RCTs) evaluating the role of a NK1RA in the prevention of emesis for patients receiving carboplatin.


A systematic review was performed in January 2017, including RCTs comparing NK1RA + dexamethasone + 5-HT3RA vs. dexamethasone + 5-HT3RA in patients receiving first cycle of carboplatin-based chemotherapy. Primary outcome was complete response (CR), defined as no emesis and no use of rescue medication. CR was measured in day 1 (acute phase), days 2-5 (delayed phase) and days 1-5 (overall period). A random effects model was applied.


9 trials were potentially eligible (7 aprepitant, 1 fosaprepitant, 1 rolapitant): 6 were RCTs including only patients receiving carboplatin, and 3 were subgroup analyses of patients receiving carboplatin within RCTs including various moderately emetogenic regimens. Data of CR were available in 8 trials (1598 patients). Addition of NK1RA improves CR in all phases: acute phase, 94.5% vs. 90.1% (Odds Ratio 1.75, 95%CI 1.19-2.59, p = 0.005); delayed phase, 76.4% vs. 61.7% (Odds Ratio 2.04, 95%CI 1.64-2.55, p 


In patients receiving carboplatin-based chemotherapy, triple antiemetic therapy with NK1RA, dexamethasone and 5-HT3RA is associated with a statistically significant and clinically relevant improvement in CR, compared to 5-HT3RA plus dexamethasone. Individual patient data meta-analysis could help to identify patients who are likely to obtain the highest improvement from the addition of NK1RA.

Clinical trial identification


Legal entity responsible for the study

Massimo Di Maio




M. Di Maio: Roles as advisor, and speaker’s fee for Merck Sharp & Dohme, AstraZeneca, Bayer, Janssen, Bristol Myers Squibb, and Eli Lilly. E. Bria: Roles as advisor, and speakers’ fee for Merck Sharp & Dohme, AstraZeneca, Celgene, Pfizer, Eli-Lilly, Bristol Myers Squibb, and Novartis. All other authors have declared no conflicts of interest.

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