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Controlling chemotherapy-induced nausea and vomiting with Neurokinin-1 receptor antagonists in patients on AC-based chemotherapy - are we there yet?
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Yap, Kevin Yi-Lwern, Leong, Cassandra and Chan, Alexandre (2012) Controlling chemotherapy-induced nausea and vomiting with Neurokinin-1 receptor antagonists in patients on AC-based chemotherapy - are we there yet? Journal of Cancer Therapy, Vol.3 (No.1). pp. 90-102. doi:10.4236/jct.2012.31012 ISSN 2151-1934.
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Official URL: http://dx.doi.org/10.4236/jct.2012.31012
Abstract
Chemotherapy-induced nausea and vomiting (CINV) are distressing side effects of chemotherapy. Neurokinin-1 receptor antagonists (NK1-RAs) have been incorporated in the contemporary management of CINV. However, clinical studies on NK1-RAs have shown mixed results in reducing CINV risk. Most studies focused on the use of aprepitant (APR) and casopitant (CAS) in breast cancer patients receiving AC-type (doxorubicin and cyclophosphamide) chemotherapy. In this study, we compared the study design and clinical efficacies of these NK1-RAs in reducing CINV risk. Among the selected eight studies, 4 APR Randomized Controlled Trials (RCTs), 2 APR Observational Studies (OSs) and 2 CAS RCTs were identified. Patient-related characteristics such as the proportion of females (60.0% - 100.0%), age (46.5 - 59.5 years), histories of motion (5.6% - 47.0% in NK1-RA arms) and morning sicknesses (14.2% - 45.0% in NK1-RA arms) and types of antiemetic regimens; as well as chemotherapy-related characteristics such as the proportion of patients on AC chemotherapy (15.0% - 100.0%) varied greatly. In terms of efficacies, both APR and CAS improved overall CR and vomiting in majority of the studies. None of the studies, however, demonstrated that NK1-RA could provide adequate nausea control. To conclude, NK1-RAs are effective in improving vomiting and overall CR, but not useful in controlling nausea or attaining CC, the ideal CINV endpoint. A shift in paradigm is needed for future CINV research. As healthcare providers continue to strive for optimum CINV control in their patients, we hope this review can help them make better informed clinical decisions.
| Item Type: | Journal Article | ||||
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| Subjects: | R Medicine > RC Internal medicine > RC0254 Neoplasms. Tumors. Oncology (including Cancer) R Medicine > RM Therapeutics. Pharmacology |
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| Divisions: | Faculty of Science, Engineering and Medicine > Engineering > WMG (Formerly the Warwick Manufacturing Group) | ||||
| Journal or Publication Title: | Journal of Cancer Therapy | ||||
| Publisher: | Scientific Research Publishing, Inc. | ||||
| ISSN: | 2151-1934 | ||||
| Official Date: | February 2012 | ||||
| Dates: |
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| Volume: | Vol.3 | ||||
| Number: | No.1 | ||||
| Page Range: | pp. 90-102 | ||||
| DOI: | 10.4236/jct.2012.31012 | ||||
| Status: | Peer Reviewed | ||||
| Publication Status: | Published | ||||
| Access rights to Published version: | Open Access (Creative Commons) | ||||
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