Source: Sun Yat-sen University Cancer Center
Written by: Yaxiong Zhang
Edited by: Wang Dongmei

Recently, Professor Li Zhang’s team at Sun Yat-sen University Cancer Center (SYSUCC) published an important article in the Journal of the National Cancer Institute: "Neurokinin-1 Receptor Antagonist-Based Triple Regimens in Preventing Chemotherapy-Induced Nausea and Vomiting: A Network Meta-Analysis" (Corresponding author Professor Li Zhang and first authors Yaxiong Zhang, Yunpeng Yang and Zhonghan Zhang). As a high-level evidence (IA), this study solved important problems in the field of chemotherapy-induced nausea and vomiting (CINV), which is expected to be written into the guidelines.

It is well-known that neurokinin-1 receptor antagonist (NK-1RA)-based triple regimen (NK-1RA + serotonin receptor antagonists (5HT₃RA) + dexamethasone) is the standard antiemetic regimen for patients with highly emetogenic chemotherapy (HEC) and/or moderately emetogenic chemotherapy (MEC). However, there are various NK-1RAs (aprepitant, casopitant, fosaprepitant, netupitant, and rolapitant) and 5HT₃RAs (first generation: ondansetron and granisetron; second generation: palonosetron) for oncologists to choose from. There is no definitive answer about whether the efficacy and toxicity of antiemesis are different amongNK-1RA-based triple regimens. It is still unclear as to whether the antiemetic efficacy in palonosetron-based triple regimens is more effective when compared with first-generation 5HT₃RAs-based triple regimens. Moreover, whether the doses of dexamethasone in combination with NK-1RA plus 5HT₃RA will impact the antiemetic effect is also unknown. Therefore, a network meta-analysis is an optimal method to solve these problems.

36 randomized controlled trials were included in the study. The study showed that different NK-1RAs-based triple regimens had an equivalent effect on the CINV control. Almost all the NK-1RAs-based triple regimens showed statistically significant better antiemetic effect when compared with duplex control regimen in patients with HEC. However, only aprepitant-based triple regimen provided statistically significantly better CINV prevention vs. duplex control regimen in patients receiving MEC. The study also found that palonosetron and first-generation 5HT₃RAs had similar effectiveness for CINV control when used with NK-1RAs and dexamethasone. There was no difference among different doses of dexamethasone (low-dose, <20 mg; moderate-dose, 20–39 mg; high-dose,>39 mg) in the prevention of CINV when combined with NK-1RAs and 5HT₃RAs.

The study confirmed that different NK-1RAs-based triple regimens are associated with an equivalent effect on CINV control in all the phases. Various NK-1RAs-based triple regimens had superior antiemetic effect than duplex control regimen in patients with HEC. Only aprepitant based triple regimen showed better CINV control compared with duplex control regimen in patients receiving MEC. Moreover, palonosetron and first-generation 5HT₃RAs might share equivalent effect on CINV control in the combination of NK-1RAs and dexamethasone. A lower dose of dexamethasone might be applied when used with NK-1RAs and 5HT₃RAs.

Professor Li Zhang is Vice Chair of the Department of Medical Oncology at SYSUCC, Vice Chair of Lung Cancer Research Center at Sun Yat-sen University, and Director of the National Anti-Cancer Drug Clinical Research Centre at SYSUCC. Dr Zhang’s research focuses on medical oncology (chemotherapy, target therapy and immunotherapy) and supportive care. He has been extensively involved in many Phase I/II studies of novel agents and international phase III trials, as a global principle investigator (PI). He has published more than 50 SCI papers in many international top-level journals like The Lancet, Lancet Oncology, Journal of Clinical Oncology and JNCI.

Link to the paper: https://academic.oup.com/jnci/article-abstract/109/2/djw217/2572051/Neurokinin-1-Receptor-Antagonist-Based-Triple?redirectedFrom=fulltext