Should clinicians always administer dexamethasone beyond 24 h after chemotherapy to control delayed nausea and vomiting caused by moderately emetogenic regimens? Insight from the re-evaluation of two randomized studies

One shot NEPA plus dexamethasone to prevent multiple-day chemotherapy in sarcoma patients

Purpose

Chemotherapy-induced nausea and vomiting (CINV) is one of the most feared and disturbing adverse events of cancer treatment associated with decreased adherence to effective chemotherapy regimens. For high-risk soft tissue sarcoma patients, receiving multiple-day chemotherapy (MD-CT), antiemetic guidelines recommend a combination of an NK₁ receptor antagonist (NK₁-RA), a 5-HT₃ receptor antagonist (5HT₃-RA), and dexamethasone on each day of the antineoplastic treatment. NEPA is the first oral fixed-dose combination of a highly selective NK₁-RA, netupitant, and second-generation 5HT₃-RA, palonosetron. So far, no data has been published in literature about the efficacy of a single dose of NEPA in MD-CT.

Methods

We performed a prospective, non-comparative study to assess the efficacy of one shot of NEPA plus dexamethasone in sarcoma patients receiving MD-CT. The primary efficacy endpoint was a complete response (CR: no emesis, no rescue medication) during the overall phase (0–120 h) in cycle 1. The main secondary endpoints were CR during the overall phase of cycles 2 and 3.

Results

The primary endpoint was reached in 88.9% of patients. Cycles 2 and 3 overall CR rates were 88.9% and 82.4%, respectively. The antiemetic regimen was well tolerated.

Conclusions

This pilot study showed the benefit of one shot of NEPA to prevent CINV in sarcoma patients receiving MD-chemotherapy.

Impact of chemotherapy on perceptions related to food intake in women with breast cancer: A prospective study

Breast cancer (BC) treatment includes mostly chemotherapy (CT), which can cause side effects like nausea, taste changes, early satiety, slow gastric emptying and xerostomia. In this way, the individual's relationship with food may change during the treatment. The aim of this study was to evaluate the impact of chemotherapy on perceptions related to food intake of women with BC. Fifty-five women with BC were followed, and data were collected at three periods during first-line CT: beginning (T0), intermediate (T1) and end (T2). A visual analogue scale (VAS) (0 to 10 cm) for hunger, appetite for various food categories and meal enjoyment was investigated. The frequency and intensity of side effects were evaluated using a 4 cm scale. The results showed a higher prevalence of taste changes in T1 (p = 0.044) and more nausea in T1 and T2 (p = 0.018). Furthermore, the intensity of nausea was higher in T2 (p = 0.01) than in the other periods. We observed moderate hunger in T0, T1 and T2 (p = 0.113), but the overall appetite increased between T0 and T2 (p = 0.003). Meal enjoyment was reduced from T0 to T1and returned back to the initial value in T2 (p = 0.021). The appetite for salty (p = 0.004) and spicy (p = 0.03) foods was increased in T1. There was an increase of body weight (p = 0.008), body mass index (BMI) (p = 0.009) and waist circumference (WC) (p = 0.03) during CT. CT changes food hedonism, increasing the overall appetite and the appetite for salty and spicy foods. Moreover, we observed the negative impact of CT on meal enjoyment and an increase in side effects and anthropometric parameters.