Efficacy of 3-day versus 5-day aprepitant regimens for long-delayed chemotherapy-induced nausea and vomiting in patients receiving cisplatin-based chemotherapy

ABSTRACTBackground Chemotherapy-induced nausea and vomiting (CINV) is an ongoing problem. While effectiveness of triplet antiemetic regimens in the delayed CINV phase (24–120 hours after administration of chemotherapy) has been studied, their effectiveness in the long-delayed phase (120–168 hours post-administration) is unknown. We compared the efficacy of 3- and 5-day courses of a triplet antiemetic prophylaxis containing aprepitant (APR) in controlling long-delayed CINV after cisplatin (CDDP)-based chemotherapy.Research design and methods We obtained patient-level data from a nationwide, multicenter, prospective observational study in Japan. The incidence and timing of CINV after 3- and 5-day APR-containing regimens were compared using inverse probability treatment weighting.Results: The analysis included 380 patients. The incidence rates of long-delayed nausea and vomiting were significantly reduced for the 5-day compared with the 3-day regimen (29.1% vs. 22.2%, p = 0.0042; 6.7% vs. 0%, p < 0.0001, respectively). Among those without CINV, vomiting was not reported after day 2 in the 5-day APR group but increased after day 4 in the 3-day APR group.Conclusion A 5-day regimen triplet antiemetic prophylaxis with APR decreased long-delayed vomiting compared with a 3-day regimen in patients receiving CDDP-based chemotherapy. However, the 5-day regimen showed no advantage over the 3-day regimen against long-delayed nausea.KEYWORDS: Antiemeticsaprepitantchemotherapy-induced nausea and vomitingcisplatinlong-delayed Declaration of interestThe authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.AcknowledgmentsWe want to thank the principal investigators of the original study, Drs. Kazuo Tamura, Keisuke Aiba, and Toshiaki Saeki, for their support of this analysis. We also thank all study participants and their families.Authors contributionsT Hayashi conceived the study concept. T Hayashi and M Shimokawa carried out the claims data analysis, while M Shimokawa performed the statistical analyses. K Matsuo provided essential technical support. All authors contributed to data interpretation and assisted in the manuscript preparation. An initial draft of the manuscript was prepared by T Hayashi and M Shimokawa. Critical revisions of the manuscript were made by T Hayashi, M Shimokawa, K Matsuo, K Kawada, T Nakano, and T Egawa. All authors reviewed and approved the final version of the manuscript.Ethics approvalAll procedures performed in studies involving human participants were conducted in accordance with the ethical standards of the Institutional Research Committee and the 1964 Declaration of Helsinki and its later amendments, or comparable ethical standards.Reviewer disclosuresPeer reviewers on this manuscript have no relevant financial or other relationships to disclose.Supplementary materialSupplemental data for this article can be accessed online at https://doi.org/10.1080/14656566.2023.2288288Additional informationFundingThis paper was not funded.