Efficacy and Safety of Aprepitant and Dexamethasone in the Prevention of Nausea and Vomiting from Neoadjuvant or Adjuvant Anthracyclines and Cyclophosphamide Combination Therapy in Patients with Breast Cancer

Abstract

Here we report the efficacy of the prophylactic antiemetic therapy that is recommended as high emetic risk by the American Society of Clinical Oncology (ASCO) guideline (2011) for anthracyclines and cyclophosphamide combination therapy (AC, CEF therapy) as neoadjuvant or adjuvant chemotherapy in breast cancer. In the National Cancer Center Hospital, aprepitant (APR) has been used in AC, CEF therapy since 2010, and additional day 2-4 dosages of dexamethasone (DEX) since 2012, following the ASCO guidelines (2006 / 2011). However, neither the efficacy nor the details of DEX dosage given concomitantly with APR in AC, CEF therapy have been fully established. We retrospectively investigated the incidence of nausea and vomiting before and after the introduction of APR therapy with or without additional use of DEX in breast cancer patients treated with preoperative or postoperative AC, CEF therapy in the hospital to confirm the efficacy and safety of the prophylactic antiemetic therapy. In 338 patients who received the treatment between January 2009 and December 2010, the incidence of vomiting decreased in the APR administered group (P = 0.020), while the degree of nausea increased (P = 0.003). In addition, in 369 patients who received the treatment between May 2011 and May 2013, the degree of nausea was significantly improved by APR with additional day 2-4 DEX dosages (P < 0.001). No adverse events associated with the additional dosage of DEX were observed. These results seem to positively support the efficacy of antiemetic prophylaxis recommended by the ASCO guideline (2011).