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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.

Date

10 Sep 2017

Session

Poster display session

Presenters

Massimo Di Maio

Citation

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

Authors

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
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Resources

Abstract 3210

Background

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.

Methods

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.

Results

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 

Conclusions

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

Funding

None

Disclosure

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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