332MO - Comparison of NEPA-based versus olanzapine/aprepitant-based antiemetic regimen for Chinese breast cancer patients undergoing highly emetogenic chemotherapy

Background

Chemotherapy-induced nausea and vomiting (CINV) is a major concern for patients receiving highly emetogenic doxorubicin and cyclophosphamide (AC) chemotherapy. Recommended antiemetic regimens incorporate neurokinin-1 receptor antagonist, 5-hydroxytryptamine type-3 receptor antagonist, corticosteroid and dopamine antagonist. The present post-hoc analyses compared 2 treatment groups of patients who were enrolled into two recently reported prospective antiemetic studies. The objectives were to compare the effectiveness of emesis control using olanzapine- versus NEPA-containing antiemetic regimens in the first cycle of AC.

Methods

Data from 120 Chinese breast cancer patients who underwent AC were included in this analysis. They were categorized into olanzapine group (aprepitant/ondansetron/dexamethasone/olanzapine) and NEPA group (NEPA [consisted of netupitant/palonosetron]/dexamethasone). Individuals filled in self-reported diaries that recorded CINV and the functional living index – emesis (FLIE) questionnaire for quality of life (QOL) assessment.

Results

During cycle 1 AC, there were no differences in complete response, complete protection and total control between the 2 groups. In the acute phase, the only significant finding was a higher rate of ‘no use of rescue therapy' in the olanzapine group (olanzapine vs NEPA: 96.7% vs 85%, p = 0.0225). In the delayed phase, no differences were found for all studied parameters. In the overall phase, there were significantly higher rates of 'no use of rescue therapy' (91.7% vs 78.6%, p = 0.0244) as well as 'no significant nausea' (91.7% vs 78.3%, p = 0.0408) in the olanzapine group. There were no significant differences in QOL between the 2 groups.

Conclusions

The results support olanzapine may be more efficacious for control of nausea. However, this analysis cannot conclusively support the superiority of either the olanzapine-based regimen or the NEPA-based regimen in terms of antiemetic efficacy or quality of life in a clinical setting of breast cancer patients who were undergoing AC.

Clinical trial identification

NCT03386617 and NCT03079219 respectively.

Editorial acknowledgement

Legal entity responsible for the study

Chinese University of Hong Kong.

Funding

Madam Diana Hon Fun Kong Donation for Cancer Research and Mundipharma.

Disclosure

W. Yeo: Honoraria (self): Mundipharma. All other authors have declared no conflicts of interest.