Prophylactic Prochloperazine Ineffective for Opioid-induced Nausea/Vomiting in Cancer

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Opioids provide effective pain control, but cause nausea in many patients with cancer, especially in early treatment.
Opioids provide effective pain control, but cause nausea in many patients with cancer, especially in early treatment.

Prophylactic treatment of opioid-induced nausea and vomiting (OINV) with prochlorperazine at the start of treatment is not recommended, according to a study published in The Oncologist.

A standard of therapy for patients with cancer is opioid administration for the management of cancer pain. Although effective, opioids cause high rates of nausea and vomiting — up to 60% of patients — especially in the early stages of treatment, leading to nonadherence, poor pain control, and decreased quality of life.

For this study, researchers randomly assigned 120 patients with cancer starting oxycodone therapy to receive prophylactic treatment with prochlorperazine 5 mg or placebo 3 times daily for 5 days. Patients received the first dose of prochlorperazine 30 to 60 minutes before the first dose of oxycodone. Baseline characteristics of patients across both study arms were well balanced.

The primary end point measured was the proportion of patients who achieved complete response (CR), defined as no incidence of emesis and no use of rescue medication during 5 days. Secondary outcomes measured the proportions of patients with emetic episodes, moderate or severe nausea, and treatment withdrawal. Quality of life was also assessed.

No significant difference in the CR rate was observed in the prochlorperazine arm (69.5%) compared with the placebo arm (63.3%) (P =.47), and no significant differences in secondary outcomes were observed between the study arms.

The most frequently reported adverse events for the study were somnolence, constipation, appetite loss, nausea, and vomiting.

Prochlorperazine was not found to be effective as prophylactic therapy for OINV in patients with cancer and routine use for this purpose is not recommended. The authors concluded that “[f]urther research is needed to evaluate whether other antiemetics would be effective in preventing OINV in specific patient populations.”

Reference

Tsukuura H, Miyazaki M, Morita T, et al. Efficacy of prophylactic treatment for oxycodone-induced nausea and vomiting among patients with cancer pain (POINT): a randomized, placebo-controlled, double-blind trial [published online October 16, 2017]. Oncologist. doi: 10.1634/theoncologist.2017-0225

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