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Meta-analysis of adjunctive non-NK1 receptor antagonist medications for the control of acute and delayed chemotherapy-induced nausea and vomiting

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Abstract

Purpose

Chemotherapy-induced nausea and vomiting (CINV) is a distressing chemotherapy-induced symptom that may adversely impact the quality of life of cancer patients.

Methods

We conducted a systematic search of the Pubmed, Bireme, and Cochrane databases for randomized clinical trials that were published in English and that evaluated the combination of adjunctive non-neurokinin 1 (NK1) antagonist drugs (i.e., neuroleptics, anticonvulsants, benzodiazepines, and cannabinoids) with 5-hydroxytryptamine 3 (5-HT3) antagonists for adult cancer patients who were scheduled to receive moderate or highly emetogenic chemotherapy. We employed the Review Manager (RevMan) Computer program Version 5.2 for statistical calculations.

Results

We included 13 studies with a total of 1,669 patients. We observed a higher complete protection for acute CINV with adjunctive medications (risk ratio (RR) = 0.55; 95 % confidence interval (CI) 0.30–1.01; p = 0.05; I 2 = 47 %), which was not the case for the delayed period (RR = 0.89; 95 % CI 0.73–1.10, p = 0.29, I 2 = 15 %). We also observed that these adjunctive medications significantly increased the complete control of nausea (RR = 0.72; 95 % CI 0.55–0.95; p = 0.02, I 2 = 83 %) and vomiting (RR = 0.61; 95 % CI 0.50–0.75; p < 0.00001; I 2 = 60 %). There was no subgroup analysis evidence of the superiority of any single group of adjunctive medications.

Conclusions

We conclude that adjunctive non-NK1 antagonist medications may be useful for CINV control. Prospective randomized studies incorporating these low-cost medications into new regimens combining 5-HT3 and NK1 antagonists may be warranted.

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Conflict of interest

The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported and also the authors have full control of all primary data and agree to allow the journal to review their data if requested.

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Authors and Affiliations

  1. Oncology Department, ABC Medical School (FMABC), Av. Principe de Gales, São Paulo, 09060-650, Brazil

    Thaiana Aragão Santana & Damila Cristina Trufelli

  2. Discipline of Public Health/Biostatistics, ABC Medical School (FMABC), São Paulo, Brazil

    Leandro Luongo de Matos

  3. Discipline of Oncology, ABC Medical School (FMABC), São Paulo, Brazil

    Felipe Melo Cruz & Auro Del Giglio

Authors
  1. Thaiana Aragão Santana
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  2. Damila Cristina Trufelli
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  3. Leandro Luongo de Matos
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  5. Auro Del Giglio
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Correspondence to Thaiana Aragão Santana.

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Santana, T.A., Trufelli, D.C., de Matos, L.L. et al. Meta-analysis of adjunctive non-NK1 receptor antagonist medications for the control of acute and delayed chemotherapy-induced nausea and vomiting. Support Care Cancer 23, 213–222 (2015). https://doi.org/10.1007/s00520-014-2392-z

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  • DOI: https://doi.org/10.1007/s00520-014-2392-z

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