Bauters, T.G., Verlooy, J., Robays, H., Benoit, Y., & Laureys, G. (2013). Emesis control by aprepitant in children and adolescents with chemotherapy. International Journal of Clinical Pharmacy, 35, 1021–1024. 

DOI Link

Study Purpose

To investigate the efficacy of aprepitant in children and young adolescents receiving highly or moderately emetogenic chemotherapy who experienced uncontrollable emesis in previous cycles

Intervention Characteristics/Basic Study Process

This was a retrospective, observational analysis in children and adolescents aged greater than three years treated with aprepitant at a hospital in Belgium. Patients were identified through pharmacy records. Data on the use of antiemetics and emesis control were retrieved from pharmacy and nursing files. Emesis was defined as at least one episode of vomiting during the current chemotherapy cycle. Complete vomiting control was defined as no vomiting during the current cycle while incomplete control was defined as at least one episode of vomiting. The use of aprepitant was recorded and analyzed for each patient and for every chemotherapy cycle in which aprepitant was given.

Sample Characteristics

  • N = 20  
  • AVERAGE AGE = 14 years (range = 8–16 years)
  • MALES: 55%, FEMALES: 45%
  • KEY DISEASE CHARACTERISTICS: Bone tumor, lymphoma, leukemia, malignant mesenchymal tumor, germ cell tumor, hepatocellular carcinoma, and relapsed nephroblastoma and neuroblastoma
  • OTHER KEY SAMPLE CHARACTERISTICS: Two patients were younger than than 11 although aprepitant is used in patients older than 11.

Setting

  • SITE: Single site    
  • SETTING TYPE: Inpatient    
  • LOCATION: Ghent University Hospital in Belgium

Phase of Care and Clinical Applications

  • PHASE OF CARE: Multiple phases of care
  • APPLICATIONS: Pediatrics

Study Design

Retrospective, observational analysis over three years 

Measurement Instruments/Methods

  • Demographic data, cancer type, chemotherapy treatment protocol, emetogenic level of the chemotherapy cycle, administration of antiemetics, and emesis control over 24 hours, after 24 hours, and overall were recorded.
  • Emesis episodes (at least one during the chemotherapy cycle) and complete vomiting control (no vomiting during the current chemotherapy cycle) were endpoints.

Results

The total data reported were for 104 episodes.
 
Complete vomiting control was observed in 89 out of 104 (85.6%) of episodes, and incomplete vomiting control was seen in 15 out of 104 episodes (14.4%). This was observed in 10 patients (50%). Of them, four experienced vomiting in the acute phase (40%) and four in the delayed phase (40%). Two patients experienced vomiting in both the acute and delayed phase (20%). In the 15 episodes of incomplete vomiting control, vomiting was observed during the acute phase in six episodes (40%), seven in the delayed phase (46.7%), and two in both the acute and delayed phases (13.3%). Eight out of 10 patients (80%) with incomplete vomiting control needed rescue therapy with alizapride (three patients [37.5%] in the acute phase, three [37.5%] in the delayed phase, and two [25%] in both the acute and delayed phases). This represented 13 (86.7%) episodes with rescue therapy, five (38.5%) in the acute phase, five (38.5%) in delayed phase, and three (23%) in both phases.

Conclusions

Half the patients, representing a sizable percentage of episodes with complete emesis control, benefited from the use of aprepitant in combination with other antiemetics. This suggested the added value of aprepitant in patients receiving moderately or highly emetogenic cycles of chemotherapy, especially as all the included patients experienced uncontrollable emesis in previous cycles. Patients or parents with a positive experience with aprepitant asked for the availability of the product in subsequent cycles, which highlights its value.

Limitations

  • Small sample (< 30) 
  • Risk of bias (no appropriate attentional control condition)  
  • Risk of bias (sample characteristics)

 

Nursing Implications

Aprepitant achieved good results in preventing or reducing vomiting in children, which might improve compliance and patient and family satisfaction.