Irinotecan-based chemotherapy regimens have high emetogenic potential and require optimized antiemetic prophylactic therapy, according to a study published in Supportive Care in Cancer

Chemotherapy-induced nausea and vomiting (CINV) is one of the biggest challenges faced during anticancer treatment. While the introduction of effective antiemetic medication has reduced the incidence of CINV, their unregulated use during oncologic drug development has led to much uncertainty regarding the emetogenic profile of newer medications.

For this prospective and retrospective study, researchers evaluated the emetogenic potential of 50 different chemotherapeutic regimens among 157 patients with cancer in the outpatient setting; 27 patients received highly emetogenic chemotherapy (HEC); 93 patients, moderately emetogenic chemotherapy (MEC); 31 patients, low emetogenic potential treatment; and 6 patients, minimal emetogenic chemotherapy.

Results showed that patients who received cisplatin and anthracycline-cyclophosphamide combination therapy, regimens classified as HEC, had CINV incidence of 37.5% and 54.4%, respectively.

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Regimens classified as MEC had a lower incidence of CINV with the exception of irinotecan; patients who received irinotecan had a CINV incidence of nearly 50%, which was more comparable with HEC regimens.

Approximately 70% of patients reported that CINV negatively affected their quality of life, and reported that nausea was the most commonly experienced symptom.

The authors concluded that “irinotecan has been associated in this study with an important incidence of nausea and vomiting, which suggests it is a drug of highly emetogenic potential, regardless of the scheme used. We suggest changing its classification from a moderately to a highly emetogenic drug,” and noted that additional efforts to improve prophylactic therapy for HEC regimens should be made.

Reference

Garcia-del-Barrio MA, Martin-Algarra S, Pastor AA. Reality of the emetogenic level of irinotecan [published online April 21, 2018]. Support Care Cancer. doi: 10.1007/s00520-018-4196-z