Efficacy and Safety of Aprepitant in Allogeneic Hematopoietic Stem Cell Transplantation

Autor: Kimiko Ichinose, Hiroaki Ikesue, Tsuyoshi Muta, Katsuto Takenaka, Kimitaka Suetsugu, Hiromi Iwasaki, Ryozo Oishi, Koji Kato, Hiromi Hiraiwa, Mayako Uchida, Asako Sakurai, Toshihiro Miyamoto, Kenichiro Nagata, Takanori Teshima, Motoaki Shiratsuchi, Koichi Akashi, Nobuaki Egashira
Rok vydání: 2013
Předmět:
Zdroj: Pharmacotherapy
ISSN: 1875-9114
0277-0008
DOI: 10.1002/phar.1294
Popis: Chemotherapy-induced nausea and vomiting (CINV) is one of the most challenging symptoms associated with cancer treatment. To maintain quality of life and enable patients to complete therapy, it is very important to control CINV with the appropriate use of antiemetics.1 Dexamethasone in combination with a 5-hydroxytryptamine 3 (5-HT3) receptor antagonist represents the standard of care in CINV associated with high-dose conditioning regimens for hematopoietic stem cell transplantation (HSCT).2–4 Although the combination of dexamethasone plus a 5-HT3 receptor antagonist is often used prior to HSCT, vomiting is not controlled in as many as 80–93% of patients.5–13 Since the neurokinin-1 receptor antagonist aprepitant was approved, the use of triple combination antiemetic therapy (i.e., dexamethasone, 5-HT3 receptor antagonist, and aprepitant) has resulted in further improvements in the control of CINV in non-HSCT patients with solid tumors who are treated with moderate to highly emetogenic chemotherapy.14–16 In addition, aprepitant has been recently reported to prevent CINV associated with high-dose preparative regimens followed by HSCT.17–21 However, there is still limited information on the safety and efficacy of aprepitant in the setting of allogeneic HSCT (allo-HSCT). Confounding factors that may lead to overlap of acute and delayed CINV in allo-HSCT include the use of calcineurin inhibitors for the control of graft-versus-host disease (GVHD), antibiotics and antifungal agents for infection prophylaxis, total body irradiation (TBI), and high-dose multiday administration of anticancer drugs.13, 22 Further, many regimens contain drugs such as cyclophosphamide and busulfan that are metabolized by cytochrome (CYP) 3A4. Aprepitant inhibits CYP 3A4,23 and concomitant use with CYP3A4 substrates may alter the pharmacokinetic properties of these drugs.24–29 Thus there is a need to evaluate the antiemetic efficacy and safety of aprepitant in conditioning regimens for allo-HSCT. In 2010, our institution began using aprepitant as part of the antiemetic prophylaxis strategy for patients undergoing allo-HSCT. The purpose of this study was to evaluate retrospectively the safety and efficacy of aprepitant in allo-HSCT patients.
Databáze: OpenAIRE
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