Fosaprepiant May Not Provide Same Benefit as Aprepitant With 5-day Cisplatin

Fosaprepitant may have a lower complete response rate than aprepitant when used in combination with a 5HT3 receptor antagonist.
Fosaprepitant may have a lower complete response rate than aprepitant when used in combination with a 5HT3 receptor antagonist.

Fosaprepitant may have a lower complete response rate than aprepitant when used in combination with a 5HT3 receptor antagonist and dexamethasone for the prevention of chemotherapy-induced nausea and vomiting in patients undergoing 5-day cisplatin combination chemotherapy, a study published in the journal Supportive Care in Cancer has shown.1

Because fosaprepitant, the intravenous formulation of aprepitant, has demonstrated noninferiority to aprepitant in single-day cisplatin chemotherapy and is approved as a single-dose alternative, researchers sought to evaluate fosaprepitant in patients receiving a multiday cisplatin regimen.

For the phase II study, researchers enrolled 65 patients with germ cell tumors receiving a 5-day cisplatin combination chemotherapy. Most patients were receiving bleomycin plus etoposide and cisplatin.

All participants received fosaprepitant 150 mg intravenously on days 3 and 5 plus a 5HT3 receptor antagonist on days 1 to 5 (if palonosetron, days 1, 3, and 5) with dexamethasone 20 mg on days 1 and 2, and 4 mg orally twice daily on days 6, 7, and 8. Patients were also able to receive rescue antiemetics.

Results showed that of the 54 evaluable patients, 24.1% of patients achieved a complete response, meaning they had no emetic episodes or used rescue medications.

“The data in this phase II study, in contrast to our prior phase III study, appears to indicate a lower [complete response] rate with the substitution of fosaprepitant for aprepitant,” the authors conclude. “It is unknown whether the substitution of fosaprepitant for aprepitant provides the same benefit in multiday cisplatin that was achieved with single-day cisplatin.”

REFERENCE

1. Adra N, Albany C, Brames MJ, et al. Phase II study of fosaprepitant + 5HT3 receptor antagonist + dexamethasone in patients with germ cell tumors undergoing 5-day cisplatin-based chemotherapy: a Hoosier Cancer Research Network study [published online ahead of print February 2, 2016]. Supp Care Cancer. doi:10.1007/s00520-016-3100-y.

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