Aprepitant (Cinvanti) for paclitaxel/ carboplatin – pro
CINVANTI is a substance P/neurokinin-1 (NK1) receptor antagonist, indicated in adults, in combination with other antiemetic agents, for the prevention of: acute and delayed nausea and vomiting associated with initial and repeat courses of highly emetogenic cancer chemotherapy (HEC) including high-dose cisplatin as a single-dose regimen; delayed nausea and vomiting associated with initial and repeat courses of moderately emetogenic cancer chemotherapy (MEC) as a single-dose regimen; and nausea and vomiting associated with initial and repeat courses of MEC as a 3-day regimen.
This drug is used mainly for Delayed Emesis (24 hours after chemotherapy): Recommendations for the prevention of delayed emesis in oncology patients receiving cisplatin and other agents of high emetic risk include the use of dexa methasone and aprepitant, for the prevention of cisplatin and non-cisplatin delayed emesis. Aprepitant (oral) and fosaprepitant (intravenous prodrug) are indicated for the prevention of nausea and vomiting. Initially, the development of aprepitant was for the prevention of chemotherapy-induced nausea and vomiting, but its use and indications have since expanded to include post-operative nausea and vomiting. Aprepitant now has FDA approval for both indications.
The Multinational Association of Supportive Care in Cancer/European Society for Medical Oncology (MASCC/ESMO), the American Society of Clinical Oncology (ASCO), and the National Comprehensive Cancer Network (NCCN) make antiemetic therapy based guidelines based on the risk of emesis. An (NK-1) receptor antagonist is recommended in combination with a 5-HT3 receptor antagonist (e.g., ondansetron) and a glucocorticoid (often dexamethasone) for highly emetogenic chemotherapy (HECT) and moderately emetogenic chemotherapy (MECT).
In Hyashi’s study, the incidence of delayed nausea was 36.1% for paclitaxel/ carboplatin regimen. It, therefore, justified aprepitant.
Aapro M, Carides A, Rapoport BL, Schmoll HJ, Zhang L, Warr D. Aprepitant and fosaprepitant: a 10-year review of efficacy and safety. Oncologist. 2015 Apr;20(4):450-8.
Hayashi T, Shimokawa M, Matsuo K, Iihara H, Kawada K, Nakano T, Egawa T. Chemotherapy-induced nausea and vomiting (CINV) with carboplatin plus pemetrexed or carboplatin plus paclitaxel in patients with lung cancer: a propensity score-matched analysis. BMC Cancer. 2021 Jan 15;21(1):7
NCCN.ORG, Supportive care 2022