Safety and efficacy of NK-1 receptor antagonist–based therapy for prevention and treatment of chemotherapy-induced nausea and vomiting in highly emetogenic chemotherapy: A systematic review and meta-analysis.

Abstract

e24123 Background: Chemotherapy-induced nausea and vomiting (CINV) significantly impact the quality of life for patients receiving highly emetogenic chemotherapy (HEC). Despite antiemetic guidelines recommending NK1 receptor antagonists (RA) in combination with other agents, their utilization remains suboptimal. This systematic review and meta-analysis evaluate the safety and efficacy of NK1 RA-based therapy for managing CINV. Methods: A comprehensive search of PubMed, Embase, and Cochrane was conducted from inception to December 2024. The primary outcomes analyzed were complete response (CR) during the acute phase (0–24 hours), delayed phase (24–120 hours), and overall phase (0–120 hours). Secondary outcomes included complete control, absence of nausea, absence of vomiting, and no use of rescue medication during the overall phase. Adverse events, including somnolence and hiccups, were also assessed. Data were analyzed using the random-effects model in RevMan (version 5.4.1). Results: This meta-analysis of 22 randomized controlled trials (RCTs) involving 5,314 patients compared NK1 RA-based therapy (n = 2,665) with non-NK1 RA-based therapy (n = 2,649). NK1 RA-based therapy significantly improved CR during the acute phase (RR: 1.24, 95% CI: 1.14–1.34, p < 0.00001), delayed phase (RR: 1.20, 95% CI: 1.11–1.31, p < 0.0001), and overall phase (RR: 1.24, 95% CI: 1.14–1.34, p < 0.00001). Complete control during the overall phase was also higher with NK1 RA-therapy (RR: 1.22, 95% CI: 1.08–1.37, p = 0.001), with fewer vomiting episodes (RR: 1.50, 95% CI: 1.21–1.87, p = 0.0002) and reduced use of rescue medication (RR: 1.10, 95% CI: 1.03–1.18, p = 0.007). However, no significant difference was observed for nausea prevention during the overall phase (RR: 1.17, 95% CI: 0.97–1.40, p = 0.09). Adverse events associated with NK1 RA-therapy included an increased risk of somnolence (RR: 1.34, 95% CI: 1.19–1.52, p < 0.00001) and hiccups (RR: 1.29, 95% CI: 1.00–1.66, p = 0.05). Conclusions: NK1 RA-based therapy demonstrates significant efficacy in improving CR across acute, delayed, and overall phases of CINV, along with better complete control, reduced vomiting episodes, and decreased use of rescue medication. Although there was no significant improvement in nausea prevention, the therapy is associated with an increased risk of somnolence and hiccups. These findings reinforce the importance of NK1 RA-based therapy in managing CINV, highlighting its benefits while emphasizing the need for personalized approaches to mitigate adverse events.