Efficacy of NEPA for prevention of chemotherapy-induced nausea and vomiting in cancer patients receiving highly emetogenic chemotherapy and usefulness of adding olanzapine for grade 2 or higher emesis

Abstract

NEPA has demonstrated superiority in preventing chemotherapy-induced nausea and vomiting (CINV) compared to palonestron and non-inferiority compared to aprepitant/granisetron. However, despite the application of NEPA in previous studies, grade (Gr) 2 or higher CINV was reported in 20% to 30% of cases. The aim of this study was to investigate the efficacy of NEPA for CINV prevention in Korean cancer patients treated with highly emetogenic chemotherapy (HEC), and to evaluate the usefulness of adding olanzapine in cases experiencing Gr 2 or higher CINV in previous cycles. A retrospective cohort study was conducted on cancer patients treated with HEC and CINV prophylaxis using NEPA. If Gr 2 or higher CINV occurred, olanzapine 5 mg/day was administered for 5 days. The primary endpoint was the incidence of Gr 2 or higher CINV during cycle 1. Secondary endpoints included the efficacy of olanzapine addition and the identification of risk factors for Gr 2 or higher CINV. 142 patients were analyzed. The median age was 66.0 years, and males were 54.2%. Tumor sites included biliary tract (44%), genitourinary (27%), and breast (9%). HEC regimens included cisplatin < 50 mg/m(2) (49%), cisplatin >= 50 mg/m(2) (20%), carboplatin (18%), and doxorubicin (12%). The incidence of Gr 2 or higher CINV was 23% (33/142), and the incidence of all-grade CINV was 58% (82/142). Among those with Gr 2 or higher CINV, 82% (27/33) were treated with olanzapine combination without dose modification of HEC, and 74% (20/27) improved to Gr 1 CINV. This study showed that NEPA was comparably effective in Korean patients treated with HEC and demonstrated the efficacy of olanzapine combination therapy. Further studies are needed to confirm CINV prophylaxis strategies, either through initial combination with olanzapine in high-risk CINV patients or by adding olanzapine in patients with prior Gr2 or higher CINV.