Does aprepitant influence response to dose-intensive cyclophosphamide, etoposide, cisplatin?

A recent study in Canada has shown similar response rates to dose-intensive cyclophosphamide, etoposide, and cisplatin (DICEP) in patients with relapsed/refractory Hodgkin lymphoma (HL) and diffuse large B-cell lymphoma (DLBCL) regardless of aprepitant use.

A total of 218 patients were enrolled in this study. Response to DICEP was observed in 87.6 percent of patients in the control group and 88.5 percent of those in the aprepitant group (difference, 0.025, 95 percent confidence interval, ‒0.066 to 0.114; p=0.827).

In univariate analyses for age, sex, type of cancer, stage of cancer, number of prior relapses, and relapse status did not show any significance. Additionally, significant differences were not seen in any of the secondary outcomes.

“Considering these results and the effectiveness of aprepitant in chemotherapy-induced nausea and vomiting (CINV), its addition to standard antiemetic therapy in patients receiving DICEP should be given strong consideration in the transplant setting,” the investigators said.

This retrospective review of patients who received full-dose DICEP for relapsed/refractory HL or DLBCL was conducted between June 1995 and September 2018 at the Foothills Medical Centre in Calgary, Alberta, Canada. The investigators used descriptive statistics to assess response rate, as defined by the 2007 International Working Group response criteria.

“Despite evidence demonstrating the effectiveness of aprepitant for CINV, its use in stem cell transplant settings across Canada is not standard,” the investigators said.

“While pharmacokinetic data exists, the clinical significance of cytochrome P450 3A4 (CYP 3A4) inhibition of cyclophosphamide by aprepitant is unclear. Reduced activation of cyclophosphamide may reduce the effectiveness of DICEP,” they added.