More Frequent Fosaprepitant Dosing May Provide Some Benefits  

Weekly fosaprepitant during concurrent chemoradiotherapy may be beneficial for some patients with nasopharyngeal carcinoma, according to research published in JAMA Network Open.

Researchers found that patients were less likely to experience emesis or clinically significant nausea when they received fosaprepitant weekly rather than every 3 weeks. However, the researchers also found no significant difference in sustained complete response between the 2 dosing regimens.

This phase 1 study (ClinicalTrials.gov Identifier: Identifier: NCT04636632) enrolled 100 patients from a single center in China. The patients had nasopharyngeal carcinoma and had achieved control of chemotherapy-induced nausea and vomiting using fosaprepitant-based regimens after 2 to 3 cycles of induction chemotherapy.

The patients were scheduled to receive intensity-modulated radiotherapy and concomitant cisplatin every 3 weeks. They were randomly assigned to receive fosaprepitant weekly (n=50) or every 3 weeks (n=50) during chemoradiotherapy.

The primary endpoint was the proportion of patients who had a sustained complete response — defined as no emesis and no rescue therapy — during concurrent chemoradiotherapy.

The proportion of patients who achieved the primary endpoint was 20.4% in the weekly arm and 12.5% in the every-3-week arm. This difference was not statistically significant (subhazard ratio, 0.66; 95% CI, 0.43-1.02; P =.06).

On the other hand, patients assigned to weekly fosaprepitant were significantly more likely to report no emesis and freedom from clinically significant nausea.

The proportion of patients with no emesis on days 1 to 21 was 52.0% in the weekly arm and 28.0% in the every-3-weeks arm (P =.005). The proportion of patients with no emesis overall was 38.0% and 14.0%, respectively (P =.003).

The proportion of patients with no clinically significant nausea on days 1 to 21 was 98.0% in the weekly arm and 78.0% in the every-3-weeks arm (P =.001). The proportion of patients with no clinically significant nausea overall was 92.0% and 72.0%, respectively (P =.002).

There were no significant differences between the arms with regard to any-grade adverse events or serious adverse events. There were no grade 4 or 5 adverse events in either arm.

Reference

Yang Q, Zou X, Xie Y-L, et al. Fosaprepitant weekly vs every 3 weeks for the prevention of concurrent chemoradiotherapy–induced nausea and vomiting: A pilot randomized clinical trial. JAMA Netw Open. Published online July 27, 2023. doi:10.1001/jamanetworkopen.2023.26127.

This article originally appeared on Cancer Therapy Advisor