3-Drug Combination May Better Reduce Nausea-Vomiting During Chemotherapy

MedicalResearch.com Interview with:
Junichi Nishimura MD, PhD
Assistant professor
Osaka University in Japan

Medical Research: What is the background for this study? What are the main findings?

Dr. Nishimura: Oxaliplatin is classified as moderately emetogenic chemotherapy and 2-drug combination antiemetic therapy is recommended for Oxaliplatin based chemotherapy including FOLFOX and XELOX in all guidelines for antiemesis. Nausea and vomiting are still frequent adverse events which decrease the patient’s QOL. However, there was no study investigating whether 3-drug combination antiemetic therapy (5HT3 receptor antagonist+dexamethasone+aprepitant) reduce chemotherapy-induced nausea and vomiting. In this study, we conducted a multicentre, randomized phase III study to evaluate the usefulness of the combined use of aprepitant in colorectal cancer patients treated with Oxaliplatin based chemotherapy. In this phase III study, 3-drug combination therapy significantly increased the inhibition rate of vomiting which was the primary endpoint of this study. Moreover, the inhibition rate of nausea, complete response (no vomiting and no rescue medication use), and complete protection (no vomiting , no rescue medication use and no moderate or worsened nausea) was significantly higher in aprepitant group in overall and delayed phase. We, next, compared the inhibition of vomiting and nausea between males and females in delayed phase. When patients were grouped by sex regardless of the assigned treatment group, females were more affected by nausea and vomiting than males. Finally, in female, aprepitant did significantly prevent nausea and vomiting as well as increased chance of complete protection.

Medical Research: What should clinicians and patients take away from your report?

Dr. Nishimura: The 3-drug combination antiemetic therapy might be an antiemetic treatment option for oxaliplatin based chemotherapy in colorectal patients who were not controlled their vomiting and nausea.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Nishimura: Casopitant, which is another NK1 receptor antagonist, were reported to have no significant effects in colorectal patients receiving oxaliplatin based chemotherapy compared with recommended 2-drug combination antiemetic therapy. We need more data about the effectiveness of 3-drug combination therapy in colorectal patients treated with Oxaliplatin to conclude whether aprepitant is recommended antiemetic therapy for Oxaliplatin based chemotherapy.


Nishimura J, Satoh T, Fukunaga M, et al, et al. A phase III trial of aprepitant in colorectal cancer patients receiving oxaliplatin-based chemotherapy (SENRI Trial). Ann Oncol. 2015;26 (suppl 4; O-001). – See more at: http://www.onclive.com/conference-coverage/2015-world-GI/adding-aprepitant-improves-control-of-oxaliplatin-related-nausea-vomiting-in-crc#sthash.0gjjzcCI.dpuf

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Junichi Nishimura MD, PhD, & Assistant professor (2015). 3-Drug Combination May Better Reduce Nausea-Vomiting During Chemotherapy