Choi, M.R., Jiles, C., & Seibel, N.L. (2010). Aprepitant use in children, adolescents, and young adults for the control of chemotherapy-induced nausea and vomiting (CINV). Journal of Pediatric hematology/oncology, 32(7), 268-271.

To describe one institution’s experience with using aprepitant to control chemotherapy-induced nausea and vomiting (CINV) in children with cancer who were receiving highly emetogenic chemotherapy (HEC) or moderately emetogenic chemotherapy (MEC) by conducting a retrospective chart review

This was a retrospective review of charts from Aug 2005 until May 2007 in the authors’ institution. The authors divided children into two groups based on whether they were given two or three antiemetic agents. Children in regimen 1 (n = 20) received 0.15 mg/kg ondansetron three times per day, 0.15 mg/kg (maximum of 20 mg) dexamethasone, and 125 mg aprepitant on day 1 followed by 80 mg aprepitant on days 2 and 3. Children in regimen 2 (n=12) received only ondansetron and aprepitant. Aprepitant was given to 24 out of 32 children whose weight was more than 20 kg at the above mentioned dosing. Children weighing less than 20 kg received 80 mg days 1–3. One child whose weight was less than 15 kg received 80 mg on day 1 and 40 mg on day 2 and 3.

• The study reported on 32 patients aged 18 years or younger at the beginning of chemotherapy treatment.
• The mean age was 10 and the range was 32 months–19 years.
• The sample was 50% male and 50% female.
• All patients had been diagnosed with childhood cancers, including sarcomas, lymphomas, leukemia, and central nervous system (CNS) tumors.

The study was conducted at a single inpatient setting in the United States.

All patients were undergoing the active phase of treatment care.

This was a retrospective chart review.

The authors reported that children younger than 12 years or weighing less than 40 kg received reduced aprepitant doses. However, they did not report how many children fell into this group, only that the mean age was 10.

Based on this report, we know that 19 children in the regimen 1 (dexamethasone,  ondansetron, and aprepitant) group did very well compared to the younger children in the regimen 2 group (ondansetron and aprepitant). In this report, dexamethasone was not reduced as suggested (12 mg on day 1 followed by 8 mg on days 2 and 3).

This retrospective study shows that aprepitant triple therapy, when combined with standard antiemetics, was well-tolerated in pediatric patients (mean age of 10 years) receiving HEC or MEC. Aprepitant was safe and well tolerated in patients age 18 or younger and improves control of CINV in children.

• The sample size was small.
• No comparison or control group was included.
• Applicability and practicality issues exist.
• Using aprepitant in children under 10–12 years of age or under 40 kg is not well established because of the effects P450 enzymes and drug-drug interactions in young children.

Aprepitant in combination with standard antiemetics is well tolerated in children. More prospective studies are needed to identify the most effective way to use aprepitant for children undergoing chemotherapy. Children with cancer who weigh more than 20 kg benefit if aprepitant is given at 125 mg on day 1 and 80 mg on days 2–3. Dexamethesone may need to be adjusted from standard dosing to 12 mg on day 1 and 8 mg on days 2 and 3 because of altered metabolism of corticosteroids by aprepitant’s inhibition of CYP3A4. Pediatric oncology nurses should be knowledgeable in cytochrome P450 enzymes and drug-drug interactions. Future research should focus on using aprepitant in very young children (less than 10 years of age or less than 40 kg weight).