Neurokinin-1 inhibitors in the prevention of nausea and vomiting from highly emetogenic chemotherapy: a network meta-analysis

Abstract

A network meta-analysis of the comparative effectiveness of neurokinin 1 (NK-1) inhibitors in the prophylaxis of highly emetogenic chemotherapy induced nausea and vomiting has been conducted. Eligible studies included randomized trials evaluating aprepitant, fosaprepitant, netupitant (NEPA), casopitant and rolapitant containing regimens in the setting of highly emetogenic chemotherapy. Primary outcomes of interest include complete response (CR) and rate of no significant nausea. After preclusion of ineligible studies, 19 studies were included in the final analysis. The majority of the regimens containing NK-1 inhibitors (including NEPA, aprepitant/palonosetron (palono)/dexamethasone (dexa), casopitant/granisetron (grani) or ondansetron (ondan)/dexa, aprepitant/ondan/dexa) are better than regimens not containing them (palono/dexa, ondan/dexa, grani/dexa) in terms of achieving a CR in the overall phase. Moreover, casopitant/grani or ondan/dexa and aprepitant/grani or ondan/dexa are better than rolapitant/ondan or grani/dexa in terms of CR achievement [odds ratio (OR) 1.62, 95% credible interval (CrI) 1.14-2.23, and OR 1.28, 95% CrI 1.01-1.59, respectively]. Taking into consideration the limitations of cross-trial comparisons, regimens containing neurokinin inhibitors are associated with higher CR rates than regimens not containing them. Moreover, casopitant and aprepitant regimens seem to be more effective than rolapitant regimens.

Keywords: chemotherapy; nausea; neurokinin; vomiting.

Figure 1.

Flowchart of study selection procedure.

Figure 2.

(a) Forest plots of odds ratio (OR) of complete response (CR) associated with different neurokinin-based regimens. (b) League table of different neurokinin-based regimens in terms of CR achievement. (c) Rankogram of different neurokinin-based regimens in terms of CR achievement. CI, credible interval; dexa, dexamethasone; grani, granisetron; ondan, ondansetron; NEPA, netupitant/palonosetron; palono, palonosetron.

Figure 3.

(a) Forest plots of odds ratio (OR) of rate of no significant nausea associated with different neurokinin-based regimens. (b) League table of different neurokinin-based regimens in terms of rate of no significant nausea achievement. (c) Rankogram of different neurokinin-based regimens in terms of rate of no significant nausea achievement. CI, credible interval; dexa, dexamethasone; grani, granisetron; ondan, ondansetron; NEPA, netupitant/palonosetron; palono, palonosetron.