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STUDY PURPOSE: To compare the effects of different regimens of NK1-based antiemetic treatment for patients receiving highly emetogenic chemotherapy (HEC) or moderately emetogenic chemotherapy (MEC)
TYPE OF STUDY: Meta-analysis and systematic review
TOTAL REFERENCES RETRIEVED: 1,796
PHASE OF CARE: Active antitumor treatment
Regimens using various NK1s showed equivalent antiemetic effect in the overall, acute, and delayed phases. In patients receiving HEC, almost all triple-drug regimens showed significantly higher complete response rates when compared to duplex antiemetic regimens. In patients with MEC, the only NK1 that showed better antiemetic effect than duplex regimens was aprepitant. Palonosetron-based regimens did not show any difference from first generation 5-HT3s for CINV complete response rate. No differences in outcomes were observed with differing doses of dexamethasone as part of a triple-drug regimen.
This analysis provides some key information regarding the specific selection of agents and regimens used for CINV control among patients receiving MEC and HEC. Consistent with other evidence, CINV was best controlled with a triple-drug regimen rather than a duplex regimen. The findings suggest that varied doses of dexamethasone do not reduce efficacy.
No quality evaluation
The findings suggest that a standard triple drug regimen is more effective for CINV control with HEC regimens compared to duplex regimens. The findings also suggest that differences in dexamethasone dosing does not appear to alter antiemetic effectiveness. Regimens with reduced use of corticosteroid may be needed for patients with diabetes or low tolerance for side effects of steroids.