Aapro, M.S., Schmoll, H.J., Jahn, F., Carides, A.D., & Webb, R.T. (2013). Review of the efficacy of aprepitant for the prevention of chemotherapy-induced nausea and vomiting in a range of tumor types. Cancer Treatment Reviews, 39(1), 113-117.

To characterize the antiemetic treatment response of aprepitant when combined with ondansetron and dexamethasone compared to ondansetron and dexamethasone alone, in multiple patient populations receiving highly emetogenic chemotherapy (HEC) and moderately emetogenic chemotherapy (MEC)

Study participants had been diagnosed with lung, breast, gastrointestinal (GI), and genitourinary (GU) tumor types and were included in four previously completed randomized control trials. Authors selected the articles for review. Inclusion and exclusion criteria were outlined for each study.

All patients were in active antitumor treatment.

The results of the post hoc analysis of the pooled data demonstrated that complete antiemetic responses were observed in a higher proportion of both HEC and MEC treated patients for all tumor types. For HEC treated patients, significant differences were found in GU (61% versus 44.7%, p = 0.001), GI (68% versus 45%, p = 0.013), and lung cancers (73% versus 53%, p = 0.001). In MEC-treated patients, a significant difference was found in breast cancer (54.9% versus 43.9%, p = 0.0001). Complete response (no vomiting and no rescue medications) following MEC ranged from 54.9% in the breast cancer group to 76% in the lung cancer group.

This analysis demonstrates the consistent efficacy of aprepitant as part of an antiemetic regimen across different tumor types and chemotherapy regimens. The authors recommend the use of an antiemetic regimen that includes aprepitant prior to the first cycle, noting that it will prevent anticipatory chemotherapy-induced nausea and vomiting (CINV) in those patients who respond to the preventative measures.

• This was not a systematic review but, rather, a report of four pooled studies examined by post hoc analysis. 
• The sample size for some of the tumor types was small. 
• This article did not address nausea but, instead, focused on vomiting and use of rescue antiemetic medications.
• The studies were believed to be from randomized trials sponsored by Merck to test efficacy of Amend.

Evidence supports the use of aprepitant in combination with other antiemetic medications for patients receiving MEC and HEC. This supports current understanding of multiple pathways leading to CINV.