Aprepitant for the prevention of nausea and vomiting associated with chemotherapy and postoperative recovery

Abstract

Chemotherapy-induced nausea and vomiting (CINV) and postoperative nausea and vomiting (PONV) can negatively impact patient quality of life, functional performance and activities of daily living. Although the development of serotonin receptor antagonists has greatly improved the control of acute emesis, delayed CINV remains a significant clinical issue. Aprepitant (Emend^®) is the first commercially available drug from a new class of agents, the neurokinin-1 receptor antagonists. Elucidation of its mechanism of action has produced a greater understanding of the pathophysiology of nausea and vomiting. Oral aprepitant, in combination with a selective serotonin (5-HT₃) receptor antagonist and corticosteroids, is indicated for the prevention of acute and delayed nausea and vomiting associated with highly and moderately emetogenic chemotherapy in adults. Aprepitant alone or in combination only with dexamethasone does not optimally control acute emesis compared with triple combination therapy. By contrast, aprepitant as monotherapy is indicated for the prevention of PONV. Aprepitant represents an emerging class of agents and its addition to standard therapy provides an advanced benefit in the prevention and treatment of CINV and PONV. Investigations of aprepitant for other indications are ongoing.

Keywords::

• antiemetic
• aprepitant
• chemotherapy-induced nausea and vomiting
• neurokinin-1
• postoperative nausea and vomiting
• substance P

Financial & competing interests disclosure

These activities were supported by grants from NIH (CA75123 and CA95026) and Targeted Diagnostic and Therapeutics, Inc. to SA Waldman. J LaRusso was enrolled in the NIH-supported institutional K30 Training Program in Human Investigation (K30 HL004522) and was supported by the NIH institutional award T32 GM08562 for Postdoctoral Training in Clinical Pharmacology. SA Waldman is the Samuel MV Hamilton Endowed Professor. SA Waldman and WK Kraft receive research support from Merck Research Laboratories. SA Waldman and WK Kraft are paid consultants to Merck. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Notes

*Modest. Adapted and modified from Prommer [5].