Pooled analysis of combination antiemetic therapy for chemotherapy-induced nausea and vomiting in patients with colorectal cancer treated with oxaliplatin-based chemotherapy of moderate emetic risk

- Pooled analysis of combination antiemetic therapy for chemotherapy-induced nausea and vomiting in patients with colorectal cancer treated with oxaliplatin-based chemotherapy of moderate emetic risk.
- Female and 2 antiemetics were risk factors for both delayed nausea (female — odds ratio [OR]: 1.918.
- Conclusions: Identifying individual risk factors can facilitate personalized treatments for delayed CINV.
- We recommend a 3-antiemetic combination prophylaxis for CRC patients treated with L-OHP-based chemotherapy, especially for female patients..
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- Colorectal cancer (CRC) is the third most commonly di- agnosed cancer in the world [1].
- Whereas chemotherapy-induced nausea and vomiting (CINV) were less prevalent for CRC patients on fluorouracil-based chemotherapy, they are a common adverse event for patients treated with L-OHP.
- However, control of delayed CINV is an un- solved issue [13, 14].
- This finding implies a need for routine antiemetic prophylaxis for delayed CINV following L-OHP-based chemotherapy [13]..
- Risk factors associated with CINV were reported to in- clude younger age, female sex, a history of CINV, and low alcohol consumption [15–23].
- Identifying risk factors for CINV in patients with CRC is important to providing them with appropriate care..
- Combinations of 3 antiemetics—2 antiemetics and NK1RA—for L-OHP-based chemotherapy were tested with a few studies.
- We therefore investigated whether delayed CINV were controlled with 3 antiemetics treatment, as well as risk factors for delayed CINV in CRC patients treated with L-OHP-based chemotherapy, based on two prospective cohort studies [25, 26] and one randomized trial [27] in Japan..
- Independent risk factors for delayed CINV were also evaluated using lo- gistic regression analysis with a backward elimination.
- Study or trial Number of cancer types Patients, n CRC patients on L-OHP-based chemotherapy.
- Risk factors for CINV.
- We performed univariate and multivariate logistic re- gression analyses of risk factors for delayed CINV,.
- including age, sex, motion sickness, drinking habit, L- OHP-based regimen and antiemetic regimen (Table 4)..
- Known risk factors, [17–25] i.e., female sex, history of motion sickness and morning sickness, were identified as risk factors for delayed CINV, whereas patients who drank alcohol five times a week and who were older ex- perienced CINV less frequently..
- Logistic regression analysis showed female sex and 2 antiemetics regimens to be common risk factors for de- layed CINV.
- The present study provides incidences of, and risk fac- tors for, delayed CINV in CRC patients receiving L- OHP-based chemotherapy, based on three prospective studies [25–27].
- 1 Incidence of delayed CINV.
- Incidences of delayed CINV were adjusted using IPTW method.
- low, and significant lower in the 3 antiemetics group..
- Multivariate analysis identified female sex and 2 anti- emetics regimens as independent risk factors for delayed CINV..
- As few clinical trials have attempted to clarify optimal antiemetic prophylaxis for CRC patients who receive L-OHP-based chemotherapy, evidence-based guidance in this setting is lacking..
- Iihara et al.
- meta-analysis [24] indicates that adding NK1RAs for pa- tients undergoing L-OHP-based chemotherapy did not have a very pronounced effect.
- Hesketh et al.
- [13] advocated the need for routine antiemetic prophylaxis for delayed CINV following L-OHP-based chemotherapy.
- Tsuji et al..
- [25] reported that delayed nausea incidence was still high for MEC, and patients on L-OHP-based regimens seemed to benefit from doublet therapy with palonose- tron or triplet therapy with aprepitant.
- Nishimura et al..
- [27] reported that three antiemetics that included apre- pitant was more effective than two antiemetics in pre- venting CINV in CRC patients on L-OHP-based regimens.
- Table 4 Risk factors for delayed CINV.
- 2 Incidence of delayed CINV by risk factor.
- The graph displays analyses of incidences of delayed CINV of male (black bars) and female (white bars) between the 2 antiemetics group and the 3 antiemetics group.
- Younger age, female sex, a history of CINV, and low alcohol consumption have been reported as well-known risk factors [15–23].
- Roscoe et al.
- Study cohorts for these reports in- cluded large percentages of breast cancer patients, whereas few studies of risk factors for CINV in CRC pa- tients have been performed.
- Takemoto et al.
- [31] re- ported that female sex and aprepitant use were risk factors for CINV in CRC patients who received L-OHP- based chemotherapy, and that 3 antiemetics regimens that included aprepitant were more effective for women than for men in preventing CINV in this setting.
- Our in- tegrated analysis showed that female sex and 2 anti- emetics regimens were independent risk factors for both delayed nausea and delayed vomiting in CRC patients on L-OHP-based chemotherapy..
- These data suggest that 2 antiemetics for prevention of delayed CINV may be sufficient for men receiving L- OHP-based regimen.
- Despite these limitations, the findings de- scribe CINV incidence and its risk factors in routine clinical practice, rather than in a controlled trial..
- This study clarified that female sex and use of only two antiemetics are risk factors of delayed CINV for CRC pa- tients who undergo L-OHP-based chemotherapy.
- We recommend combining three antiemetics as prophylaxis for CRC patients treated with L-OHP-based chemother- apy, especially female patients..
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