Casopitant prevents chemotherapy-induced nausea and vomiting

NEW YORK (Reuters Health) - The addition of casopitant to dexamethasone and ondansetron prevents chemotherapy-induced nausea and vomiting in patients receiving cisplatin-based highly emetogenic chemotherapy, according to a report in the May 11th online issue of The Lancet Oncology.

"As we understand more about the mechanisms of chemotherapy-induced emesis, we can prevent and treat this problem more effectively," Dr. Steven M. Grunberg from University of Vermont, Burlington, told Reuters Health. "We should be able to prevent vomiting in most patients if we use our antiemetics early and do not wait until the problem has already appeared."

In a phase III trial, Dr. Grunberg and colleagues assessed the efficacy and safety of a single oral dose, and a 3-day intravenous and oral dose, of casopitant in combination with dexamethasone plus ondansetron; this was compared with dexamethasone plus ondansetron only (control group) for the prevention of chemotherapy-induced nausea and vomiting in patients receiving cisplatin-based chemotherapy.

Overall complete response rates were higher in the single-dose casopitant group (86%) and 3-day intravenous and oral casopitant group (80%) than in the control group (66%), the authors report.

More patients in the casopitant groups than in the control group reported no nausea, complete protection, and no vomiting during all phases, although the incidence of emesis in the first 8 to 12 hours after the first cycle of chemotherapy was similar across the groups.

Moreover, a greater percentage of patients in the casopitant groups reported that chemotherapy-induced nausea and vomiting had no effect on daily life activities.

The benefits of casopitant persisted in the first four cycles of chemotherapy, the researchers note.

Casopitant was generally well tolerated, the investigators say, with similar proportions of patients in the casopitant and control groups reporting adverse events, the most common being neutropenia, leucopenia, anemia, and thrombocytopenia.

"NK-1 antagonists such as casopitant can make a difference in decreasing acute and delayed nausea and vomiting after chemotherapy," Dr. Grunberg said. "The growing body of evidence suggests that a single appropriate dose of antiemetic just before chemotherapy may be enough to decrease nausea and vomiting not only on the day of treatment but also for the 5-day period of risk of vomiting that follows chemotherapy."

"The studies done so far have all combined casopitant with ondansetron and dexamethasone against highly or moderately emetogenic chemotherapy in adults," Dr. Grunberg explained. "We would hope to see trials using casopitant with other antiemetic agents, in special populations (such as children and young adults), and for other types of emeses (such as radiation-induced nausea and vomiting)."

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