Triple Antinausea Therapy Benefits Patients with Multiple Myeloma During Induction Therapy

In a recent phase III trial, a 3-medication regimen showed efficacy in reducing treatment-related nausea and vomiting in patients with multiple myeloma undergoing induction therapy before autologous stem cell transplant.

In a recent phase III trial, a 3-medication regimen showed efficacy in reducing treatment-related nausea and vomiting in patients with multiple myeloma undergoing induction therapy before autologous stem cell transplant.

In patients with multiple myeloma, as in other cancers, treatment is often associated with a high burden of nausea and vomiting that may reduce adherence, and subsequently, treatment efficacy.¹

In a phase III trial published on September 15, 2014 in the Journal of Clinical Oncology, Schmitt et al assessed the effects of aprepitant, granisetron, and dexamethasone as a combination treatment for prevention of chemotherapy-induced nausea and vomiting induced by high-dose melphalan before autologous stem cell transplant in patients with multiple myeloma.¹

In this randomized, placebo-controlled trial, for the 4 days before autologous stem cell transplant, 362 patients were randomized in a 1:1:1 ratio to¹:

• Maximal treatment with aprepitant 125 mg daily on day 1, followed by 80 mg daily on days 2 through 4, and treatment with granisetron 2 mg daily for 4 days, and dexamethasone at a 4-mg loading dose on day 1 followed by 2-mg doses on day 2 and 3;
• Granisetron alone 2 mg daily for 4 days and dexamethasone at a 4-mg loading dose on day 1, followed by 2-mg doses on day 2 and 3; or
• Placebo.

Patient quality of life was assessed with a questionnaire (Functional Living Index-Emesis) administered on days 1 and 5 after the transplant. Aprepitant significantly increased the rate of response to treatment, from 41% with double antinausea therapy to 58% with triple antinausea therapy including aprepitant (P = .0042). Quality of life scores also significantly increased versus patients treated with placebo (P <.001).¹

Triple therapy in patients with multiple myeloma may be a reasonable strategy for improving quality of life when undergoing autologous stem cell transplant. Although the results of triple therapy trials have been less clear in some other disease states in which patients receive moderately emetogenic chemotherapy,² with highly emetogenic regimens, the benefits of triple therapy are clearer.³

Triple therapy appears to be a reasonable strategy for improving patient quality of life in patients with multiple myeloma receiving induction therapy before autologous stem cell transplant.¹

References:

• Schmitt T, Goldschmidt H, Neben K, et al. Aprepitant, Granisetron, and Dexamethasone for Prevention of Chemotherapy-Induced Nausea and Vomiting After High-Dose Melphalan in Autologous Transplantation for Multiple Myeloma: Results of a Randomized, Placebo-Controlled Phase III Trial. J Clin Oncol. 2014.
• Yeo W, Mo FK, Suen JJ, et al. A randomized study of aprepitant, ondansetron and dexamethasone for chemotherapy-induced nausea and vomiting in Chinese breast cancer patients receiving moderately emetogenic chemotherapy. Breast Cancer Res Treat. 2009;113(3):529-535.
• Hesketh PJ, Grunberg SM, Gralla RJ, et al. The oral neurokinin-1 antagonist aprepitant for the prevention of chemotherapy-induced nausea and vomiting: a multinational, randomized, double-blind, placebo-controlled trial in patients receiving high-dose cisplatin--the Aprepitant Protocol 052 Study Group. J Clin Oncol. 2003;21(22):4112-4119.