Assessment of the Change of Antiemetic Prophylaxis From a Double Combination to a Triple Combination in Oncology Patients With High Dose Carboplatin Chemotherapy

Abstract

Abstract Purpose:To compare the effectiveness of netupitant/palonosetron and dexamethasone triple combination(TC) therapy versus ondansetron/dexamethasone double combination(DC) therapy as antiemetic prophylaxis in patients with solid tumors after a moderated emetic regiment of carboplatin AUC≥4. As a secondary endpoint, in TC group we evaluated the effectiveness of changing NEPA administration timing from 1 hour to 15 minutes before chemotherapy. Methods:Single institution prospective study in which assignment to groups was not randomized. Patients receiving carboplatin AUC≥4 enrolled the study. Chemotherapy-induced nausea and vomiting (CINV) was evaluated using MASCC antiemetic tool, in acute (<24h) and delayed phase (24–120h), in DC vs TC. Results were analyzed using χ2 test. Results:Two-hundred four completed questionnaires (CQ) were analyzed, 76 belonging to DC and 128 to TC. The proportion of patients who remained emesis-free was superior for TC-treated group compared to DC, either in acute (99.2% vs 92%, p=0.0109) and delayed phase (97.6% vs 90.5%, p=0.042). Likewise, a higher proportion of TC-treated patients compared to DC, remained nausea-free for the first 24 hours after treatment (90.6% vs 72%, p=0.0005) and after 120 hours (82.3% vs 63.5%, p=0.0031). Comparison of the change in NEPA administration time showed similar effectiveness in terms of CINV control (81.6% vs 74.5% p=0.70). Conclusions:A triple antiemetic combination should be used in carboplatin AUC≥4 regimens. TC showed superiority in early and delayed CINV control, with no significant differences among different cancer types. Change in NEPA administration timing has beneficial implications; it allows NEPA to be administered at hospital, before chemotherapy session, instead of at home.