Poster Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2018

The incidence and severity of breakthrough nausea and vomiting with palonosetron & dexamethasone requiring addition of NK1-receptor antagonists (NK1RA) in subsequent cycles in three highly or high-risk moderately emetogenic chemotherapy (HEC and high MEC) regimens (#249)

Eunice Dai 1 , Stephen Della-Fiorentina 1
  1. Macarthur Cancer Therapy Centre, Campbelltown, NSW, Australia


Primary aims assessed incidence of breakthrough chemotherapy-induced nausea and vomiting (CINV) in patients receiving fluorouracil-leucovorin-oxaliplatin (FOLFOX), carboplatin-gemcitabine (Carbo/Gem), and carboplatin-paclitaxel (Carbo/PTX) with palonosetron/dexamethasone (PALO/DEX) prophylaxis, as well as the incidence / efficacy of secondary CINV-prophylaxis with triple-therapy (NK1RA + 5HT3-receptor-antagonist + dexamethasone). 

Secondary aim investigated whether Pharmaceutical Benefits Scheme listing of NEPA (Netupitant/palonosetron) would increase NK1RA-triple therapy utilisation.



A retrospective analysis of breakthrough-CINV and subsequent NK1RA-triple therapy incidence and efficacy in FOLFOX, Carbo/Gem and Carbo/PTX at Macarthur Cancer Therapy Centre was performed.  Data was reviewed from 14 months pre- and 10 months post-NEPA listing ((04/01/2016 – 31/03/2017), (03/04/2017 – 28/03/2018) respectively).  Patient data, treatment details and outcomes were extracted using Mosaiq®, an institutional electronic database.  Severity of CINV was described as grade 1-4 (G1-4) per the CTCAEv4.01.  NK1RA use was negligible in carboplatin-regimens, thus analysis of NK1RA-outcomes was restricted to use in FOLFOX.



Of 191 patients reviewed across 3 regimens, 140 (73%) experienced breakthrough-CINV. 

The proportion of patients experiencing events was higher in FOLFOX than Carbo/Gem or Carbo/PTX in grades 1-2 nausea (63% vs 27% vs 50%, 27% vs 4% vs 2%, respectively), and grades 1-2 emesis (16% vs 4% vs 3%, and 5% vs 0% vs 0%, respectively).  One patient on carbo/gem experienced grade 3 nausea (2%) and grade 3 emesis (2%).  No G4 events reported. 

Frequency of NK1RA secondary prophylaxis for FOLFOX-CINV was similar pre- and post-NEPA listing (9/53 (17%); and 11/48 (23%), respectively).  There was minimal use of NK1RA in combined Carboplatin-regimens over the whole study period (2/90 (2%)).

NK1RA-triple-therapy as secondary prophylaxis in FOLFOX-CINV was effective in G1 emesis in 4/4 (100%), though showed no improvement G2 emesis in 2 patients analysed.



In breakthrough-CINV with PALO/DEX for FOLFOX, secondary prophylaxis with NK1RA-based triple-therapy showed a trend towards preventing G1 emesis and improving G2 nausea.

  1. 1. U.S. Department of Health and Human Services. Common Terminology Criteria for Adverse Events (CTCAE) Version 4.0, 14 June, 2010. Accessed 1/5/2018.