GLs-recommended antiemetic treatment improves emesis in most patients (pts) receiving CT. Non-adherence to GLs leads to suboptimal CINV control. MASCC/ESMO GLs recommend prophylaxis with a neurokinin-1 receptor antagonist (NK1RA), a 5-hydroxytryptamine-3 (5-HT3) RA, and dexamethasone (DEX) for pts receiving highly emetogenic CT (HEC, including anthracycline-cyclophosphamide [AC]) and carboplatin-based regimens. Here, we analyse use of NK1RA + 5-HT3RA + DEX for antiemetic prophylaxis prior to HEC and carboplatin (considered moderately EC [MEC]).
The data source was the Global Oncology Monitor (Ipsos Healthcare). Geographically representative physicians from France, Germany, Italy, Spain, and UK were screened for treatment involvement and number of pts treated/month. Pts’ data from Jan–Dec 2017 were collected and extrapolated based on a doctor universe; projected estimates are shown here. The emetic risk of CT was classified per MASCC/ESMO GLs.
Antiemetic treatment use is shown (Table). Data from 46,503 pts treated with CT were collected, which represents a total prevalence of 1,468,522 CT-treated pts included in the analysis. NK1RAs were used in 39%/36%/23% of pts receiving cisplatin-/AC-/carboplatin-based CT, respectively; 18%/20%/11% received the GLs-recommended NK1RA + 5-HT3RA + DEX combination; 17% of all HEC-/MEC-treated pts received no antiemetics. Physicians’ perception of the emetic risk of CT did not follow MASCC/ESMO GLs classification for 48%/48%/43% of cisplatin-/AC-/carboplatin-based regimens.Table: 1681O
Use of NK1RA-based prophylactic antiemetic treatments for CINV by emetic risk of chemotherapy according to the MASCC/ESMO guidelines classification
|Chemotherapy regimen||Total patients,* %, n||Patients with NK1RAs,* %, n||NK1RA + 5-HT3 RA + DEX, %||NK1RA + 5-HT3RA, %||NK1RA + DEX, %||NK1RA monotherapy, %||NK1RA + other antiemetics, %|
|HEC – cisplatin based||55% of HEC 211,600||39% 81,827||18% 38,804||16% 33,363||2% 4,935||2% 4,554||0% 172|
|HEC – AC based||39% of HEC 151,185||36% 54,724||20% 30,955||12% 18,601||2% 3,497||1% 1,419||0% 252|
|HEC – other||6% of HEC 22,219||17% 3,803||2% 515||13% 2,894||1% 144||1% 234||0% 15|
|MEC – carboplatin based||30% of MEC 177,027||23%, 40,317||11% 18,839||10% 17,484||1% 1,995||1% 1,656||0% 343|
|Total (all HEC + carboplatin based)||38% of all patients 562,032||32% 180,671||16% 89,114||13% 72,342||2% 10,571||1% 7,862||0% 783|
5-HT3RA, 5-hydroxytryptamine-3 receptor antagonist; AC, anthracycline-cyclophosphamide; CINV, chemotherapy-induced nausea and vomiting; DEX, dexamethasone; HEC, highly emetogenic chemotherapy; MASCC/ESMO, Multinational Association of Supportive Care in Cancer/European Society for Medical Oncology; MEC, moderately emetogenic chemotherapy; NK1RA, neurokinin-1 receptor antagonist.*
Estimate of total number of patients is based on the projected prevalence of total 1,468,522 patients being treated with chemotherapy. A sample of 46,503 patients was used for the projections.
EU practice patterns revealed very low adherence to antiemetic GLs in clinical practice, with 16% of all pts (HEC/AC/carboplatin) receiving an NK1RA + 5-HT3RA + DEX, and 17% of HEC-/MEC-treated pts receiving no antiemetics. New strategies to improve GLs adherence are critically needed.
Clinical trial identification
Legal entity responsible for the study
Editorial and medical writing support was provided by Iratxe Abarrategui, PhD, CMPP, from TRM Oncology, The Hague, The Netherlands, and funded by Helsinn.
M.S. Aapro: Advisor, honoraria: Eisai, Helsinn, Merck, Mundipharma, Tesaro; Research grants: Helsinn, Merck, Tesaro. F. Scotté: Member of advisory boards or speaker: Roche, Amgen, Tesaro, Vifor, MSD, Pierre Fabre Oncology, Leo Pharma, Sanofi, Helsinn, Pfizer. L. Celio: Advisor: Italfarmaco SpA. R.D. Berman: Honoraria for seminars and lectures: Chugai, Tesaro. A. Franceschetti, D. Bell: Employee: Ipsos. K. Jordan: Consultant or received honoraria: Helsinn Healthcare, Tesaro, Merck/MSD. All other authors have declared no conflicts of interest.