Aprepitant plus palonosetron for the prevention of postoperative nausea and vomiting after breast cancer surgery: a double blind, randomized trial

Author(s)

Thiago Ramos Grigio ^[1] ; Angela Maria Sousa ; Gabriel Guimarães Nunes Magalhães ^[3] ; Hazem Adel Ashmawi ^[4] ; Joaquim Edson Vieira ^[5]

Affiliation

^[1] Universidade de Sao Paulo. Hospital das Clinicas HCFMUSP, Faculdade de Medicina. Anestesia, Instituto do Cancer do Estado de Sao Paulo (ICESP) - Brasil

^[3] Universidade de Brasilia. Faculdade Medicina. Campus Darcy Ribeiro - Brasil

^[4] Universidade de Sao Paulo. Hospital das Clinicas HCFMUSP, Faculdade de Medicina. Anestesiologia Experimental LIM-08 - Brasil

^[5] Universidade de Sao Paulo. Cirurgia, Faculdade de Medicina FMUSP - Brasil

• Document type: Journal article
• Source: Clinics; v. 75, 2020-09-02.

Abstract

OBJECTIVES: To evaluate the addition of a fourth antiemetic intervention in patients at high risk for postoperative nausea and vomiting (PONV). METHODS: High-risk patients (Apfel score 3 or 4) scheduled for unilateral mastectomy were randomly allocated in one of two groups, oral aprepitant (oral aprepitant 80 mg, intravenous dexamethasone 8 mg, and palonosetron 0.075 mg) and oral placebo (oral placebo, intravenous dexamethasone 4 mg, and palonosetron 0.075 mg). Patients and caregivers were blinded to the group assignments. The primary efficacy endpoints included the incidence of nausea and vomiting, and the secondary endpoints included use of rescue antiemetics during a 48-hour postoperative period. ClinicalTrials.gov: NCT02431286. RESULTS: One hundred patients were enrolled in this study and 91 were analyzed, 48 in group A and 43 in group P. No patient presented with nausea or vomiting in the first 2 hours after surgery. From the 2nd to the 6th hour, the incidence of PONV was 8.33% in group A and 9.30% in group P. In the first 24 hours, the incidence of PONV was 27.08% in the group A and 20.93% in group P. From the 24th to the 48th hour, the incidence of PONV was 8.33% in group A and 13.95% in group P. There were no statistically significant differences in PONV between groups. CONCLUSION: The addition of aprepitant as a third antiemetic resulted in no significant reduction in the incidence of PONV in this population. However, the incidence of PONV was reduced in relation to the general population. (AU)

• FAPESP's process: 12/11298-8 - Evaluation of palonasetron and palonasetron/aprepitant in the incidence of postoperative nausea and vomiting in the high risk oncological patientes based on the Apfel score
• Grantee: Angela Maria Sousa
• Support Opportunities: Regular Research Grants
• FAPESP's process: 15/00867-0 - Effect of palonosetron and the association palonosetron/aprepitant on the incidence of postoperative nausea and vomiting in high-risk oncological patients
• Grantee: Liam Eichenberger da Silva Mc Auliffe
• Support Opportunities: Scholarships in Brazil - Scientific Initiation