Some features associated with control of chemotherapy-induced vomiting (CIV) in pediatric patients were described in a recent study published in the Journal of Clinical Oncology.
“To our knowledge, this is the largest study to date to evaluate factors associated with CIV control in pediatric patients,” wrote the study investigators in their report.
The study was a pooled analysis of 5 clinical trials involving patients younger than 18 years who received antiemetic prophylactic therapy in conjunction with highly or moderately emetogenic chemotherapy. The primary endpoint of the study was complete acute-phase CIV control. Complete CIV control during the delayed phase was an additional endpoint. A total of 735 patients were evaluated in acute-phase analysis, and 300 were evaluated in delayed-phase analysis.
For acute-phase analysis, the mean patient age was 8.9 years, and in this analysis older patients reportedly experienced slightly less complete CIV control (relative risk [RR], 0.97 per year; 95% CI, 0.96-0.98 per year). Complete CIV control was also less likely for patients with more extended acute-phase durations (RR, 0.89 per day; 95% CI, 0.84-0.94 per day). Achieving complete acute-phase CIV control was associated with also achieving complete delayed-phase CIV control.
Ondansetron given in combination with aprepitant or fosaprepitant showed a higher association with complete acute-phase CIV control than was seen with ondansetron as a single agent (RR, 1.28; 95% CI, 1.09-1.50). This combination also gave a greater likelihood of delayed-phase complete CIV control.
According to the study investigators, the level of acute-phase CIV control was lower in pediatric patients in this study than has been reported in adult patients, and delayed-phase control was also poor. “The effectiveness of clinical practice guideline–consistent antiemetic prophylaxis must be evaluated,” concluded the study investigators in their report.
Dupuis LL, Tomlinson GA, Pong A, Sung L, Bickham K. Factors associated with chemotherapy-induced vomiting control in pediatric patients receiving moderately or highly emetogenic chemotherapy: a pooled analysis. J Clin Oncol. Published online May 18, 2020. doi:10.1200/JCO.20.00134