Postoperative Nausea and Vomiting, Solid Tumour
Conditions
Keywords
Ramosetron, aprepitant, dexamethasone, cancer, chemotherapy, antiemetics, cisplatin, nausea, vomiting, high dose cisplatin
Brief summary
Cisplatin is one of the most emetogenic drugs used in clinical practice and it could result in poor compliance with chemotherapy. The 5-HT3 receptor antagonists prevent vomiting in acute phase emesis after chemotherapy in 73 - 92% of cisplatin-treated patients when coadministered with steroids, but they appear to lack efficacy in the delayed phase emesis. Ramosetron, a new 5-HT3 receptor antagonists, has been shown to have equivalent efficacy and tolerability and a longer duration of effect than granisetron in preventing acute vomiting in patients undergoing cisplatin-containing chemotherapy. Acute phase emesis was prevented in 84.8% of patients receiving ramosetron plus dexamethasone, but the CR rate of total phase emesis was less than 60%. Aprepitant is a selective, high-affinity NK1 receptor antagonist. Adding aprepitant to 5-HT3 receptor antagonists and steroid improve CR rate of not only chemotherapy induced acute emesis and but also delayed emesis by 11-14 and 20 percentage points, respectively. But until now, there was no information that which 5-HT3 receptor antagonists is the best partner for aprepitant. Therefore, we initiated a prospective, open-label, phase II study to assess the efficacy and tolerability of a combination of ramosetron, aprepitant and dexamethasone (RAD) in the prevention of cisplatin based CINV in chemotherapy-naïve patients with solid cancer
Detailed description
Cisplatin is one of the most emetogenic drugs used in clinical practice and it could result in poor compliance with chemotherapy. The 5-HT3 receptor antagonists prevent vomiting in acute phase emesis after chemotherapy in 73 - 92% of cisplatin-treated patients when coadministered with steroids, but they appear to lack efficacy in the delayed phase emesis. Ramosetron, a new 5-HT3 receptor antagonists, has been shown to have equivalent efficacy and tolerability and a longer duration of effect than granisetron in preventing acute vomiting in patients undergoing cisplatin-containing chemotherapy. Acute phase emesis was prevented in 84.8% of patients receiving ramosetron plus dexamethasone, but the CR rate of total phase emesis was less than 60%.
Interventions
Day 1: Aprepitant 125 mg PO, 1 hour before chemotherapy Ramosetron 0.6 mg IV, 30 min before chemotherapy Dexamethasone 12 mg PO, 30 min before chemotherapy Day 2 - 3: Aprepitant 80 mg PO. in the morning Dexamethasone 8 mg PO. in the morning Day 4 Dexamethasone 8 mg PO. in the morning
Sponsors
Merck Sharp & Dohme LLC
Hallym University Medical Center
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
PREVENTION
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to 75 Years
Healthy volunteers
No
Inclusion criteria
* 18 -75 years, both sex * ECOG performance status 0-2 * Histologically proven solid cancer, chemotherapy-naïve patient * Planed to receive cisplatin (≥ 50mg/m2) based, single day chemotherapy, * No nausea or vomiting within 72 hours prior to chemotherapy * Serum Cr \< 2.5 mg/dl, or calculated CCr ≥ 50 ml/min * Serum total bilirubin \< 2 mg/dl, AST/ALT \< 3 times the upper normal limit , ALP \< 5 times the upper normal limit * Absolute neutrophil count ≥ 1,500/μL, platelet ≥ 100,000/μL * Expected life duration ≥ 3 months * Patients must sign an informed consent indicating that they are aware of the investigational nature of the study in keeping with the policy of the hospital
Exclusion criteria
* Patients with active infection, severe heart disease, uncontrollable hypertension or diabetes mellitus, active gastric or duodenal ulcers, or pregnancy or breast-feeding * Patients who should take steroid, antiemetics, pimozide, terfenadine, astemizole, cisapride, rifampin, carbamazepine, phenytoin, ketoconazole, itraconazole, nefazodone, troleandomycin, clarithromycin, ritonavir or nelfinavir for the treatment of other diseases * Patients taking any medicine, which could affect study results, within 1 week before chemotherapy (or taking anti-emetics within 48 hours before chemotherapy). Prior to beginning chemotherapy, single-agent benzodiazepines as hypnotic is allowed, but it can't be receiving during day 1-6 of 1st chemotherapy cycle. * Patients with symptomatic brain metastasis * Patients with GI obstruction or other diseases that could provoke nausea and vomiting * Patients receiving RT on brain, abdomen or pelvis within 2 weeks before chemotherapy * Patients who cannot understand informed consent or express his/her condition * Patients who cannot swallow drugs * Patients who have known allergy or severe side effect on study drugs
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Complete response (CR) rate of RAD for the prevention of chemotherapy induced nausea vomiting (CINV) during overall phase (form 1 to 5 days) (overall phase is defined as acute and delayed phase) | from chemotherapy day 1 to day 5 |
Secondary
| Measure | Time frame |
|---|---|
| CR rate of RAD for the prevention of acute and delayed phase of CINV (from 0 to 24 hours /from 2 to 5 days) | until 1 month after chemotherapy |
| Severity of nausea | until 1 month after chemotherapy |
| Time to first occurrence of vomiting | until 1 month after chemotherapy |
| Adverse events reported using CTCAE v3.0 | until 1 month after chemotherapy |
Countries
South Korea
Outcome results
None listed