Comparing the efficacy of a triplet antiemetic regimen in patients with esophageal cancer patients and diabetes mellitus treated with cisplatin-based chemotherapy: A retrospective study

Introduction: Cisplatin-based highly emetogenic chemotherapy is recommended in combination with neurokinin-1 receptor antagonist (NK1RA), 5-hydroxytriptamine-3-receptor antagonist (5HT3RA), dexamethasone (DEX), and olanzapine. However, olanzapine is contraindicated in patients with pre-existing diabetes mellitus (DM). This study compared the efficacy of a triplet antiemetic regimen (NK1RA, 5HT3RA, and DEX) in patients with and without pre-existing DM treated with cisplatin-based chemotherapy. Methods: This retrospective study enrolled patients with esophageal cancer with and without pre-existing DM who received fluorouracil and cisplatin (FP) combination chemotherapy as initial therapy with a triplet antiemetic regimen for antiemetic prophylaxis. This data was compared using propensity score matching (PSM). The primary endpoint was the complete response (CR) rate during the first cycle, which was defined as no emetic episodes and no rescue medication use during the overall period (0–120 h). The CR rate was analyzed using univariate and multivariate logistic regression, including previously reported risk factors. The significance level was set at 5%. Results: Out of 210 eligible patients, 39 and 39 were patients with DM and non-DM patients after PSM, respectively. The CR rate measured by multivariate analysis during the overall period with DM and non-DM was 56.4% and 41.0% (adjusted odds ratio of 0.566 [95% confidence intervals: 0.209–1.536], P = 0.264), respectively. The CR rate during the delayed period (24–120 h) with DM and non-DM patients was 84.6% and 46.2% (P = 0.002), respectively. Conclusions: A triplet antiemetic regimen in patients with esophageal cancer with pre-existing DM might be more effective in delayed period compared to non-DM patients.