Felix-Ukwu F, et al. - An inquiry was set up with regard to the efficacy of aprepitant for the treatment of acute chemotherapy-induced nausea and vomiting (CINV) in children and adolescents with acute lymphoblastic leukemia receiving high-dose methotrexate. A reduction was noted in both CINV and the use of rescue antiemetics with the aprepitant therapy. Aprepitant did not exert an impact on the pharmacokinetics of methotrexate. The prescription of granisetron was more frequent than ondansetron. However, great variation was reported in the selection of secondary and tertiary agents, if any were advised.

Methods

• The scheme of this study was a retrospective cohort analysis.
• It comprised of patients with ALL who received methotrexate 5 g/m²/dose with and without concomitant aprepitant.
• It was carried out at Texas, Children's Hospital between October 1, 2010 and January 31, 2016.

Results

• 16 patients who received a total of 69 courses of methotrexate were enrolled for this trial.
• It included the administration of an enhanced antiemetic regimen containing aprepitant with 42 methotrexate courses.
• A 54% reduction was noted with the use of as-needed antiemetics (P = 0.002, 95% CI: 21-89%).
• No statistically marked variations were reported in methotrexate area under the curve values (2,209 μM hr/l ± 151 vs. 2,051 μM hr/l ± 94, P = 0.355) or end-infusion methotrexate concentrations (80.5 μM ± 5.6 vs. 74.7 μM ± 3.2, P = 0.335) in patients receiving a standard when compared to an enhanced antiemetic regimen.