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Supportive and palliative care

2325 - Fosaprepitant reduces the impact of nausea on daily function during five weeks of chemo-radiotherapy – a sub-study of the GAND-emesis trial


09 Sep 2017


Supportive and palliative care


Supportive Care and Symptom Management


Christina Ruhlmann


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


C.H. Ruhlmann1, T.B. Christensen2, L. Hammer Dohn3, M. Paludan4, E. Roennengart2, F. Hilpert5, P. Feyer6, G. Kristensen7, O. Hansen1, D. Keefe8, J. Herrstedt1

Author affiliations

  • 1 Department Of Oncology, Odense University Hospital, 5000 - Odense/DK
  • 2 Department Of Oncology, Herlev Hospital, 2730 - Herlev/DK
  • 3 Department Of Oncology, Rigshospitalet, Copenhagen University Hospital, 2100 - Copenhagen/DK
  • 4 Department Of Oncology, Aarhus University Hospital, 8000 - Aarhus/DK
  • 5 Department Of Oncology, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel/DE
  • 6 Department Of Radiation Oncology, Vivantes Clinics Neukoelln, Berlin/DE
  • 7 Department For Gynecologic Cancer, Oslo University Hospital, Oslo/NO
  • 8 Rah Cancer Centre, Royal Adelaide Hospital, Adelaide/AU


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Abstract 2325


The GAND-emesis trial, a multinational, randomised, double-blind, placebo-controlled phase III trial, in women with cervical cancer receiving fractionated radiotherapy and weekly cisplatin 40 mg/m2, demonstrated an increase of 17% in the proportion of patients completing five weeks of treatment without vomiting when fosaprepitant (FOS) was added to palonosetron (PAL) and dexamethasone (DEX) (Ruhlmann et al, Lancet Oncol, 2016). As a secondary endpoint we investigated whether there was any difference in impairment of daily functional life between groups as a result of nausea or vomiting.


The validated Functional Living Index – Emesis (FLIE) questionnaire consists of 18-items to measure the impact of nausea (9 items domain) and vomiting (9 items domain) on daily functional life. The FLIE-questionnaire was completed at baseline and again at end of study (EoS). The scores for each domain and the total score were calculated according to the FLIE Manual. Domain scores ≥ 54 and total score ≥ 108 indicate no or minimal impact on daily life. The Kruskal-Wallis H test was used to test the difference between groups.


Two hundred and thirty-four patients from four countries were randomised and received study medication. Nine patients were excluded due to invalid questionnaires. Included were 115 patients receiving FOS and 110 patients receiving placebo (PLA). The point scores at baseline were similar across groups (FOS vs PLA); nausea domain: 59.9 vs 60.3 (p = 0.31); vomiting domain: 61.9 vs 62.1 (p = 0.16); and total score: 121.8 vs 122.4 (0.37). At EoS, a statistically significant difference was demonstrated for the point scores for the nausea domain and the total score (FOS vs PLA); nausea domain: 54.9 vs 53 (p = 0.02); vomiting domain: 61.4 vs 60.9 (p = 0.10); and total score: 116.3 vs 113.9 (p = 0.01).


This is the first study to investigate safety, efficacy, and impact on daily function of a neurokinin-1 receptor antagonist during the entire course of concomitant chemo-radiotherapy. The addition of FOS to PAL and DEX not only improved emetic control but also gave a clinically and statistically significant reduction of the impact of nausea on patients’ daily functional life.

Clinical trial identification

EudraCT number: 2009-014691-21. ClinicalTrials.gov: NCT 01074697.

Legal entity responsible for the study

Sponsors delegate and coordinating investigator Christina H. Ruhlmann/for sponsor Prof. Jørn Herrstedt, Odense University Hospital


unrestricted grants from Biovitrum and Helsinn Healthcare S.A.


F. Hilpert: Grants from Riemser Pharma during the conduct of the study. P. Feyer: Grants from Riemser Pharma during the conduct of the study; advisory consultant for MSD, outside the submitted work. D. Keefe: Grants from Helsinn, other from Merck, outside the submitted work J. Herrstedt: Unrestricted grant from Helsinn Healthcare, and an unrestricted grant from SOBI, during the conduct of the study; personal fees from Tesaro outside the submitted work. All other authors have declared no conflicts of interest.

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