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Research article
Koichi Goto
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Background: Of patients receiving moderate emetic risk chemotherapy (MEC), 30%–90% experience chemotherapy-induced nausea and vomiting (CINV); however, the optimal antiemetic treatment remains controversial.
Methods: In this multicenter, prospective, observational study of adults treated with MEC while receiving chemotherapy for various cancer types in Japan, the enrolled patients kept diaries documenting CINV. All participants received a 5-hydroxytryptamine-3 receptor antagonist and dexamethasone.
Results: Of the 400 patients enrolled from May 2013 to January 2015, 386 were eligible for evaluation. The median age was 64 (range, 26–84). The overall complete response (CR; no emetic events and no antiemetic measures) rate was 64%. The proportion of patients showing CR was low in the carboplatin (CBDCA)- and oxaliplatin-based chemotherapy groups, especially among women. We showed that the CR rates in men were high in the CBDCA (AUC5) + etoposide (ETP) (80%), capecitabine plus oxaliplatin (CAPOX) (78%), and CBDCA+ paclitaxel (PTX) groups for lung cancer (73%). Total control (TC; no emetic events, no antiemetic measures, and no nausea) and complete control (CC; no emetic events, no antiemetic measures, and less than mild nausea) were achieved in 51% and 61% of patients, respectively. Logistic regression analysis revealed that no history of motion sickness, no history of pregnancy-associated vomiting, and non-CBDCA-based chemotherapy are independent risk factors for CR, whereas no history of motion sickness and no history of pregnancy-associated vomiting are independent risk factors for TC.
Conclusion: Our data showed that two antiemetics were insufficient to control CINV in patients receiving CBDCA- or oxaliplatin-based chemotherapy. However, two antiemetics may be sufficiently effective for elderly male patients receiving CBDCA (AUC5)+ETP, CBDCA+PTX for lung cancer, or CAPOX. Additionally, we consider that three antiemetics are necessary for women with colorectal cancer receiving CAPOX. Risk factor analysis related to CR showed that CINV prophylaxis in patients treated with CBDCA-based chemotherapy was generally supportive of the guideline-recommended three antiemetics. However, the control of nausea in patients receiving non-CBDCA-based chemotherapy is a key point to note. The further individualization of antiemetic regimens for patients receiving MEC based on both types of chemotherapy regimens and sex is needed.
Keywords
antiemetic therapy, chemotherapy-induced nausea and vomiting (CINV), moderate emetic risk chemotherapy (MEC), NK-1 receptor antagonist, 5-HT3 receptor antagonist
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On 25 Aug, 2020
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On 15 Aug, 2020
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Editorial decision: Minor revision
On 12 Aug, 2020
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On 09 Aug, 2020
Editor invited
On 08 Aug, 2020
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On 05 Aug, 2020
Version 2
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Editorial decision: Minor revision
On 31 Jul, 2020
Review #1 received
Received 28 Jul, 2020
Reviewer #1 agreed
On 08 Jul, 2020
Reviewers invited
Invitations sent on 07 Jul, 2020
Editor assigned
On 06 Jul, 2020
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On 05 Jul, 2020
Editor invited
On 05 Jul, 2020
No comments provided
Editorial decision: Major revision
On 27 May, 2020
Review #2 received
Received 07 May, 2020
Reviewer #2 agreed
On 14 Apr, 2020
Review #1 received
Received 05 Apr, 2020
Reviewers invited
Invitations sent on 24 Mar, 2020
Reviewer #1 agreed
On 24 Mar, 2020
Editor invited
On 02 Mar, 2020
Editor assigned
On 17 Feb, 2020
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See the published version of this preprint at BMC Pharmacology and Toxicology.
This is a preprint, a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
Koichi Goto
Corresponding Author
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
View the published article at BMC Pharmacology and Toxicology.
No community comments so far
Submission checks complete
On 30 Aug, 2020
Editorial decision: Accept
On 25 Aug, 2020
No comments provided
Submission checks complete
On 15 Aug, 2020
No comments provided
Editorial decision: Minor revision
On 12 Aug, 2020
Editor assigned
On 09 Aug, 2020
Editor invited
On 08 Aug, 2020
Submission checks complete
On 05 Aug, 2020
Version 2
Posted 10 Jul, 2020
No comments provided
Editorial decision: Minor revision
On 31 Jul, 2020
Review #1 received
Received 28 Jul, 2020
Reviewer #1 agreed
On 08 Jul, 2020
Reviewers invited
Invitations sent on 07 Jul, 2020
Editor assigned
On 06 Jul, 2020
Submission checks complete
On 05 Jul, 2020
Editor invited
On 05 Jul, 2020
No comments provided
Editorial decision: Major revision
On 27 May, 2020
Review #2 received
Received 07 May, 2020
Reviewer #2 agreed
On 14 Apr, 2020
Review #1 received
Received 05 Apr, 2020
Reviewers invited
Invitations sent on 24 Mar, 2020
Reviewer #1 agreed
On 24 Mar, 2020
Editor invited
On 02 Mar, 2020
Editor assigned
On 17 Feb, 2020
Submission checks complete
On 16 Feb, 2020
First submitted
On 15 Feb, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published article at BMC Pharmacology and Toxicology.
Background: Of patients receiving moderate emetic risk chemotherapy (MEC), 30%–90% experience chemotherapy-induced nausea and vomiting (CINV); however, the optimal antiemetic treatment remains controversial.
Methods: In this multicenter, prospective, observational study of adults treated with MEC while receiving chemotherapy for various cancer types in Japan, the enrolled patients kept diaries documenting CINV. All participants received a 5-hydroxytryptamine-3 receptor antagonist and dexamethasone.
Results: Of the 400 patients enrolled from May 2013 to January 2015, 386 were eligible for evaluation. The median age was 64 (range, 26–84). The overall complete response (CR; no emetic events and no antiemetic measures) rate was 64%. The proportion of patients showing CR was low in the carboplatin (CBDCA)- and oxaliplatin-based chemotherapy groups, especially among women. We showed that the CR rates in men were high in the CBDCA (AUC5) + etoposide (ETP) (80%), capecitabine plus oxaliplatin (CAPOX) (78%), and CBDCA+ paclitaxel (PTX) groups for lung cancer (73%). Total control (TC; no emetic events, no antiemetic measures, and no nausea) and complete control (CC; no emetic events, no antiemetic measures, and less than mild nausea) were achieved in 51% and 61% of patients, respectively. Logistic regression analysis revealed that no history of motion sickness, no history of pregnancy-associated vomiting, and non-CBDCA-based chemotherapy are independent risk factors for CR, whereas no history of motion sickness and no history of pregnancy-associated vomiting are independent risk factors for TC.
Conclusion: Our data showed that two antiemetics were insufficient to control CINV in patients receiving CBDCA- or oxaliplatin-based chemotherapy. However, two antiemetics may be sufficiently effective for elderly male patients receiving CBDCA (AUC5)+ETP, CBDCA+PTX for lung cancer, or CAPOX. Additionally, we consider that three antiemetics are necessary for women with colorectal cancer receiving CAPOX. Risk factor analysis related to CR showed that CINV prophylaxis in patients treated with CBDCA-based chemotherapy was generally supportive of the guideline-recommended three antiemetics. However, the control of nausea in patients receiving non-CBDCA-based chemotherapy is a key point to note. The further individualization of antiemetic regimens for patients receiving MEC based on both types of chemotherapy regimens and sex is needed.
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