Original Report

Impact of aprepitant on emesis control, dose intensity, and recurrence-free survival in a population-based cohort of head and neck cancer patients receiving high-dose cisplatin chemotherapy


Background Standard care for locally advanced head and neck cancer (HNC) patients consists of high-dose cisplatin with radiation to prolong recurrence-free survival (RFS). However, poorly controlled emesis can compromise optimal dose intensity (DI) and affect disease control.

Objective To evaluate the impact of aprepitant on emesis control, DI, and RFS.

Methods HNC patients treated at the British Columbia Cancer Agency were analyzed. Kaplan-Meier method and adjusted Cox proportional hazard models were used to evaluate RFS in aprepitant users. To control for selection bias, a propensity score analysis was conducted.

Results A total of 192 HNC patients were included: 141 received aprepitant prophylaxis. The aprepitant-treated and untreated groups were comparable in mean age (56.3 vs 58.1 years), male gender (82.3% vs 86.3%), tumor location, and number of metastatic sites. However, more patients in the aprepitant group than in the untreated group had surgically resectable disease (31.2% vs 15.7%, respectively) and better performance status (ECOG 0/1, 87.9% vs 76.4%). Less emesis was reported in the aprepitant group (21.3% vs 28.0%). Patients in the treated group were also more likely to complete 3 cycles of high-dose cisplatin (OR, 2.3; P = .03). The propensity score adjusted Cox regression analysis suggested a reduced risk of disease recurrence in patients who received aprepitant (HR, 0.47; 95% CI, 0.17- 1.28).

Limitations Potential confounders such as other diseases or treatments that may have influenced the presence of nausea/emesis symptoms.

Conclusion Aprepitant contributed to improved emesis control, enhanced DI, and better adherence to cisplatin chemotherapy.

Funding/sponsorship The British Columbia Cancer Foundation and Canadian Cancer Society Research Institute.

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