Table 6.

Outcomes achieved with aprepitant in the prevention of CINV due to moderately emetogenic chemotherapy (all P values vs standard therapy without aprepitant unless otherwise stated)

Level of evidence	Design	Chemotherapy regimen	Antiemetic treatment	Outcome				Reference
				Acute phase		Delayed phase
				Complete response (%)a	Nausea (median VAS scores; 0=none; 100=worst)	Complete response (%)a	Nausea (median VAS scores; 0=none; 100=worst)
2	DB, MC, PG	Cyc 750–1500 mg/m2 alone or Cyc 500–1500 mg/m2 + Dox ≤60 mg/m2 or Epi ≤100 mg/m2, 4 cycles	Day 1: Ap 125 mg + Ond 8 mg + Dex 12 mg before chemo and Ond 8 mg after 8 h Day 2–3: Ap 80 mg (n=438)	NR	0	Cycle 1: 50.8 (P=0.017) Cycle 4 (n=344): 34.5 (P=0.017)	Cycle 1: 60.9b Cycle 4 (n=344): 74.1b	Herrstedt et al. 2005bc
			Day 1: Ond 8 mg + Dex 20 mg + Pla before chemo and Ond 8 mg after 8 h Day 2–3: Ond 8 mg bid (n=428)	NR	NR	Cycle 1: 42.5 Cycle 4 (n=307): 23.9 (P=0.017)	Cycle 1: 55.7b Cycle 4 (n=344): 71.3b
2	DB, MC, PG	Cyc 750–1500 mg/m2 alone or Cyc 500–1500 mg/m2 + Dox ≤60 mg/m2 or Epi ≤100 mg/m2, 4 cycles	Day 1: Ap 125 mg + Ond 8 mg + Dex 12 mg before chemo and Ond 8 mg after 8 h Day 2–3: Ap 80 mg (n=438)	76 (P=0.034 vs Pla)	NR	55	61b	Warr et al. 2005b
			Day 1: Ond 8 mg + Dex 20 mg + Pla before chemo and Ond 8 mg after 8 h Day 2–3: Ond 8 mg bid (n=428)	69	NR	49	56b
3	OL, MC	Most common regimens Dox + Cyc and Pac + Car (no further details)	Day 1: Ap 125 mg + Pal 0.25 mg + Dex 12 mg Day 2–3: Ap 80 mg + Dex 8 mg (n=39)	90		80		Grote et al. 2004
3	MC	Dox ≤60 mg/m2 + Cyc ≥500 mg/m2, 2 cycles	Day 1: Ond 8 mg, Dol 100 mg, or Gra 1 or 2 mg + Dex 8–10 mg Day 2–3: Dex 4 mg bid (n=34; cycle 1)	32	0j	12	12j	Hesketh et al. 2006b
			Day 1: Ond 8 mg, Dol 100 mg, or Gra 1 or 2 mg + Dex 8–10 mg + Ap 125 mg Day 2–3: Dex 4 mg qd + Ap 80 mg (n=34; cycle 2)d	68 (P=0.01 vs cycle 1)	21e	44 (P=0.02 vs cycle 1)	3e

^aDefined as no vomiting or use of rescue medication;

^bPercentage of patients reporting no significant nausea (peak VAS <25);

^cExtension of Warr et al. 2005b;

^dPatients continued to cycle 2, with addition of aprepitant as salvage antiemetic therapy, if they failed to achieve complete control in cycle 1;

^ePercentage of patients reporting no significant nausea (4-point scale).

Ap, aprepitant; bid, twice daily; Car, carboplatin; CINV, chemotherapy-induced nausea and vomiting; Cyc, cyclophosphamide; DB, double-blind; Dex, dexamethasone; Dol, dolasetron; Dox, doxorubicin; Epi, epirubicin; Gra, granisetron; h, hour; MC, multicenter; NR, not reported; OL, open-label; Ond, ondansetron; Pac, paclitaxel; Pal, palonosetron; PG, parallel-group; Pla, placebo; qd, once daily; VAS, visual analog scale.