Jingyi Yin, Ping Li

Department of Oncology, The First Affiliated Hospital of Jinan University, Guangzhou.

Objective: To assess the efficacy and safety of aprepitant for the prevention of chemotherapy-induced nausea and vomiting (CINV) after moderately or highly emetogenic chemotherapy. Method: Studies were identified by searching PubMed (1980 to 2015), EMbase(1980 to 2015), Cochrane Libraries(Issue5, 2015), CNKI(1980to 2015), CBMdisc(1980 to 2015), and Wan Fang Date(1980 to 2015). Randomized controlled trials of aprepitant for the prevention of CINV were included. The quality of included studies was assessed and meta-analysis was performed for the results of homogeneous studies by RevMan 5.0.23 software. Major study endpoints were complete responseto treatment (CR; defined as no emesis and no useof rescue medications) in overall phase (OP; 0–120 hours of chemotherapy), acute phase (AP; 0−24hours) and delayed phase (DP; 24–120 hours). Additionally, we assessed the control of nausea and toxicity profile (TP). Stouffer’s Z-score method was used to calculate the overall effect. Result: 15 RCTs (4,623 pts) were included. 2,316 pts received highly emetogenic chemotherapy (HEC) and 2,307 pts received moderately emetogenic chemotherapy (MEC). Aprepitant group increased CR in OP from 47% to 63% (OR=2.17, CI 1.61 to 2.91; P<0.001), in AP from 73% to 81% (P<0.01), and in DP from 51% to 66% (P<0.001). Significant increase in nausea control was seen in DP (P=0.03) but not in OP or AP. Incidence of various toxicities was statistically similar in both groups except slightly higher rate of fatigue (P=0.02) and hiccups (P<0.001), Racial sub group analysis, there were significant differences in different ethnic groups, a group curative effect best in Europe (OR=3.70, CI 1.58 to8.53; P<0.001). Conclusion: Aprepitant can improve the controlof vomiting, but has slight effect on nausea. Patients receiving AC regimen benefit less than patients receiving cisplatin chemotherapy. In view of his cost, pharmacoeconomics researches of aprepitant should be considered.

Key Words: Aprepitant  CINV chemotherapy