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.