Is the addition of a neurokinin-1 receptor antagonist beneficial in moderately emetogenic chemotherapy?

• Verfasst von: Jordan, Karin [VerfasserIn]
• Verfasst von: Müller-Tidow, Carsten [VerfasserIn]
• Titel: Is the addition of a neurokinin-1 receptor antagonist beneficial in moderately emetogenic chemotherapy?
• Titelzusatz: a systematic review and meta-analysis
• Verf.angabe: Karin Jordan, Luisa Blättermann, Axel Hinke, Carsten Müller-Tidow, Franziska Jahn
• Jahr: 2018
• Umfang: 12 S.
• Fussnoten: Gesehen am 20.08.2018 ; Online veröffentlicht: 31. August 2017
• Titel Quelle: Enthalten in: Supportive care in cancer
• Ort Quelle: Berlin : Springer, 1993
• Jahr Quelle: 2018
• Band/Heft Quelle: 26(2018), 1, Seite 21-32
• ISSN Quelle: 1433-7339
• DOI: doi:10.1007/s00520-017-3857-7
• Datenträger: Online-Ressource
• Sprache: eng
• Sach-SW: Carboplatin
• Sach-SW: Chemotherapy-induced nausea and vomiting (CINV)
• Sach-SW: Moderately emetogenic chemotherapy (MEC)
• Sach-SW: Neurokinin-1 receptor antagonist (NK1RA)
• Sach-SW: Oxaliplatin
• K10plus-PPN: 1580192920

Abstract

Purpose: This systematic review evaluates the efficacy of neurokinin-1 receptor antagonists (NK1RAs) for the prevention of chemotherapy-induced nausea and vomiting (CINV) in moderately emetogenic chemotherapy (MEC) excluding anthracycline-cyclophosphamide-based regimens. Methods: A systematic review of MEDLINE (via PubMed and OVID) and Central databases, plus major oncology conferences, identified randomized trials evaluating NK1RAs in combination with a 5-HT3 RA plus a glucocorticoid for management of CINV. Efficacy endpoints were complete response (CR), no emesis and no nausea rates. Data were analyzed using a random effects model. Results: Sixteen trials (3848 patients) were identified. Results were separately analyzed for (a) pure MEC regimens (excluding regimens containing carboplatin or oxaliplatin), (b) carboplatin-based regimens, and (c) oxaliplatin-based regimens. (a) Two trials (abstracts) enrolled 715 patients. The odds ratio for overall CR with the addition of an NK1-RA was 1.46 (95% 1.06-2.02; p = 0.02) with an absolute risk difference (RD) of 8%. (b) Nine trials (1790 patients) were identified. The OR for achieving an overall CR was 1.96 (95% CI 1.57-2.45; p < 0.00001) in favor of the NK1RA containing regimen with an RD of 15%. (c) Three trials (1190 patients) were identified. The OR for achieving an overall CR was 1.34 (95% CI 0.88-2.04; p = 0.17) not reaching statistical significance with a RD of 4%. Conclusion: Clear clinically significant benefit was seen with the addition of NK1RAs in carboplatin-based chemotherapy. A global benefit of an NK1RA containing regimen for the whole MEC category cannot be attested yet and warrants more randomized trials exclusively testing pure MEC regimens without carboplatin.