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Prof. Li Zhang's team publishes important article about chemotherapy-induced nausea and vomiting

June 05, 2017

Professor Li Zhang's team published an important article in the Journal of the National Cancer Institute: "Neurokinin-1 Receptor Antagonist-Based Triple Regimens in Preventing Chemotherapy-Induced Nausea and Vomiting: A Network Meta-Analysis".

Corresponding author Professor Li Zhang and first authors Yaxiong Zhang, Yunpeng Yang and Zhonghan Zhang conducted a high-level evidence (IA), study solving important problems in the field of chemotherapy-induced nausea and vomiting (CINV). The study is expected to be written into international guidelines.

It is well-known that neurokinin-1 receptor antagonist (NK-1RA)-based triple regimen (NK-1RA + serotonin receptor antagonists (5HT3RA) + dexamethasone) is the standard antiemetic regimen for patients with highly emetogenic chemotherapy (HEC) and/or moderately emetogenic chemotherapy (MEC). However, there are various NK-1RAs (aprepitant, casopitant, fosaprepitant, netupitant, and rolapitant) and 5HT3RAs (first generation: ondansetron and granisetron; second generation: palonosetron) for oncologists to choose from. There is no definitive answer about whether the efficacy and toxicity of antiemesis are different amongNK-1RA-based triple regimens. It is still unclear as to whether the antiemetic efficacy in palonosetron-based triple regimens is more effective when compared with first-generation 5HT3RAs-based triple regimens. Moreover, whether the doses of dexamethasone in combination with NK-1RA plus 5HT3RA will impact the antiemetic effect is also unknown. Therefore, a network meta-analysis was an optimal method to solve these problems.

36 randomized controlled trials were included in the study. The study showed that different NK-1RAs-based triple regimens had an equivalent effect on the CINV control. Almost all the NK-1RAs-based triple regimens showed statistically significant better antiemetic effect when compared with duplex control regimen in patients with HEC. However, only aprepitant-based triple regimen provided statistically significantly better CINV prevention vs. duplex control regimen in patients receiving MEC. The study also found that palonosetron and first-generation 5HT3RAs had similar effectiveness for CINV control when used with NK-1RAs and dexamethasone.  There was no difference among different doses of dexamethasone (low-dose, <20 mg; moderate-dose, 20–39 mg; high-dose, >39 mg) in the prevention of CINV when combined with NK-1RAs and 5HT3RAs.

The study confirmed that different NK-1RAs-based triple regimens are associated with an equivalent effect on CINV control in all the phases. Various NK-1RAs-based triple regimens had superior antiemetic effect than duplex control regimen in patients with HEC. Only aprepitant based triple regimen showed better CINV control comparedwith duplex control regimen in patients receiving MEC. Moreover, palonosetron and first-generation 5HT3RAs might share equivalent effect on CINV control in the combination of NK-1RAs and dexamethasone. A lower dose of dexamethasone might be applied when used with NK-1RAs and 5HT3RAs.

Professor Li Zhang's team

For the published article see here: https://academic.oup.com/jnci/article-abstract/109/2/djw217/2572051/Neurokinin-1-Receptor-Antagonist-Based-Triple?redirectedFrom=fulltext

Professor Li Zhang
Department of Medical Oncology, Sun Yat-sen University Cancer Center
Vice Chair of the Department of Medical Oncology
Vice Chair of Lung Cancer Research Center at Sun Yat-Sen UniversityDirector of the National Anti-Cancer Drug Clinical Research Centre at Sun Yat-Sen University Cancer Center

Dr Zhang’s research is focuses on medical oncology (chemotherapy, target therapy and immunotherapy) and supportive care. He has been extensively involved in many Phase I/II studies of novel agents and international phase III trials, as a global principle investigator (PI). He has published more than 50 SCI papers in many international top-level journals like the "Lancet", "Lancet Oncology", "Journal of Clinical Oncology" and "JNCI".

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