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Review
. 2024 Mar;129(3):457-466.
doi: 10.1007/s11547-024-01757-3. Epub 2024 Feb 14.

Impact of fosaprepitant in the prevention of nausea and emesis in head and neck cancer patients undergoing cisplatin-based chemoradiation: a pilot prospective study and a review of literature

Carlotta Becherini  1 , Viola Salvestrini  2 , Isacco Desideri  1 , Giulia Vagnoni  3 , Ilaria Bonaparte  1 , Niccolò Bertini  1 , Chiara Mattioli  1 , Lucia Angelini  1 , Luca Visani  1 , Vieri Scotti  1 , Lorenzo Livi  1 , Saverio Caini  4 , Pierluigi Bonomo  1
Affiliations
Review

Impact of fosaprepitant in the prevention of nausea and emesis in head and neck cancer patients undergoing cisplatin-based chemoradiation: a pilot prospective study and a review of literature

Carlotta Becherini et al. Radiol Med. 2024 Mar.

Abstract

Purpose: Cisplatin-based chemoradiotherapy (CRT) is standard treatment for head and neck squamous cell carcinoma (HNSCC). However, IMRT may increase chemotherapy-induced nausea and vomiting (CINV). The purpose of this study is to investigate the effect of fosaprepitant in preventing CINV.

Methods: An infusion of 150 mg fosaprepitant was given through a 30 min. We assessed acute toxicity using CTCAE v.4 and the incidence of CINV using the FLIE questionnaire. The evaluation of CINV was done at the second and fifth weeks of CRT and 1 week after the end. The EORTC QLQ-HN 43 questionnaire was administered before treatment beginning (baseline), at second (T1) and fifth (T2) weeks. A dosimetric analysis was performed on dorsal nucleus of vagus (DVC) and area postrema (AP).

Results: Between March and November 2020, 24 patients were enrolled. No correlation was found between nausea and DVC mean dose (p = 0.573), and AP mean dose (p = 0.869). Based on the FLIE questionnaire, patients reported a mean score of 30.5 for nausea and 30 for vomiting during week 2 and 29.8 for nausea and 29.2 for vomiting during week 5. After treatment ended, the mean scores were 27.4 for nausea and 27.7 for vomiting. All patients completed the EORTC QLQ-HN 43. Significantly higher scores at T2 assessment than baseline were observed.

Conclusions: The use of fosaprepitant in preventing CINV reduced incidence of moderate to severe nausea and vomiting. No correlation has been found between nausea and median dose to DVC and AP.

Keywords: Chemoradiotherapy; Chemotherapy-induced nausea; Emesis; Fosaprepitant; Head and neck cancer.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Dose distribution and dosimetric data for dorsal vagal complex (DVC) and area postrema (AP). a cT4aN0 oropharynx, DVC, dorsal vagal complex; AP, area postrema; b RT mean dose to vomiting center structures
Fig. 2
Fig. 2
FLIE score assessment at baseline, after 2 and 5 weeks
Fig. 3
Fig. 3
Eating-related domains (A. pain in the mouth, B. swallowing; C. problems with teeth; D. dry mouth and sticky saliva; E. problems with senses; F. social eating; G. problems opening mouth; H. weight loss) of HN43 questionnaire at baseline, T1 and T2 assessment
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