Combination Antiemetic Therapy for Chemotherapy-Induced Nausea and Vomiting in Patients with NSCLC Receiving Carboplatin-Based Chemotherapy

Mototsugu Shimokawa,1,2,&ast; Naoki Haratake,3,&ast; Kazuki Takada,4 Gouji Toyokawa,5 Shinkichi Takamori,6 Fumitaka Mizuki,7 Tomoyoshi Takenaka,3 Toshinobu Hayashi8 1Department of Biostatistics, Graduate School of Medicine, Yamaguchi University, Yamaguchi, Japan; 2Cancer Biostatistics Laboratory, Clinical Research Institute, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan; 3Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; 4Department of Surgery, Saiseikai Fukuoka General Hospital, Fukuoka, Japan; 5Department of Surgery, National Hospital Organization Fukuoka National Hospital, Fukuoka, Japan; 6Department of Thoracic Oncology, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan; 7Center for Clinical Research, Yamaguchi University Hospital, Yamaguchi, Japan; 8Department of Pharmaceutical and Health Care Management, Faculty of Pharmaceutical Sciences, Fukuoka University, Fukuoka, Japan&ast;These authors contributed equally to this workCorrespondence: Mototsugu Shimokawa, Department of Biostatistics, Graduate School of Medicine, Yamaguchi University, 1-1-1 Minamikogushi, Ube, Yamaguchi, 755-8505, Japan, Tel +81-836-22-2805, Fax +81-836-22-2805, Email moto@yamaguchi-u.ac.jp Toshinobu Hayashi, Department of Pharmaceutical and Health Care Management, Faculty of Pharmaceutical Sciences, Fukuoka University, 8-19-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan, Tel +81-92-871-6631, Email toshinobu@fukuoka-u.ac.jpPurpose: The incidence of delayed chemotherapy-induced nausea and vomiting (CINV) in patients with non-small cell lung cancer (NSCLC) receiving carboplatin (CBDCA)-based chemotherapy (CBDCA + pemetrexed or paclitaxel) has not been clearly described. Therefore, we attempted to evaluate whether delayed CINV could be controlled using a combination of three antiemetics and identify individual risk factors.Methods: We pooled data from two prospective observational studies, namely a nationwide survey of CINV and a prospective, observational study in Japan, to assess whether delayed CINV could be controlled using a combination of three antiemetics and identified individual risk factors via inverse probability treatment-weighted analysis.Results: In total, 240 patients were evaluable in this study (median age, 66 years; male, 173; female, 67). The three-antiemetic regimen controlled delayed nausea (31.6% vs 47.3%) and vomiting (5.1% vs 23.1%) better than two antiemetics. Younger age (< 70 years; odds ratio [OR] = 2.233), motion sickness (OR = 3.472), drinking habits (OR = 1.972), receipt of the CBDCA + pemetrexed regimen (OR = 2.041), and the use of two antiemetics (OR = 1.926) were risk factors for delayed nausea. Female sex (OR = 3.372), drinking habits (OR = 2.272), receipt of the CBDCA+ pemetrexed regimen (OR = 2.314), and the use of two antiemetics (OR = 6.830) were risk factors for delayed vomiting.Conclusion: Female sex, younger age, and receipt of the CBDCA + pemetrexed regimen increased the risk of CINV. Therefore, we recommend additional supportive antiemetics treatment for these patients.Keywords: NSCLC, aprepitant, carboplatin, nausea, vomiting