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Background <p>Carboplatin (CBDCA) is highly emetogenic when administered at an area under the curve (AUC) ≥ 4, requiring triple antiemetic therapy, including an NK<sub>1</sub> receptor antagonist (NK<sub>1</sub> RA). Fosnetupitant (F-NTP), a long-acting NK<sub>1</sub> RA, may provide sustained receptor occupancy; however, its direct comparisons with aprepitant (APR) in CBDCA-based regimens between 0 and 168&#xa0;h remain lacking. We aimed to evaluate the antiemetic efficacy of F-NTP versus APR during 1&#xa0;week following chemotherapy.</p> Methods <p>This retrospective single-center observational study included patients with cancer receiving CBDCA (AUC ≥ 4)-based regimens. Propensity score matching was performed using clinical factors. The primary endpoint was the complete response (CR; no emesis or rescue medication) rate between 0 and 168&#xa0;h. The secondary endpoints included phase-specific CR rates, time to treatment failure (TTF), and adverse events (AEs).</p> Results <p>After matching, 242 patients were included in each group. The overall CR rate at 0–168&#xa0;h was significantly higher with F-NTP (83.5%) than with APR (69.4%) (<i>p</i> &lt; 0.001). F-NTP significantly prolonged TTF (hazard ratio = 0.48, 95% confidence interval: 0.33–0.71, <i>p</i> &lt; 0.001). The multivariate analysis revealed female sex, younger age, and high CBDCA dose as significant risk factors for non-CR, while F-NTP use was a protective factor. AEs did not differ significantly between the groups and were mostly Grade 1.</p> Conclusion <p>F-NTP demonstrated superior antiemetic efficacy to that of APR in CBDCA-based regimens, particularly maintaining higher CR rates through the acute and delayed phases. F-NTP was also well tolerated, supporting its potential as a strong prophylactic agent for preventing chemotherapy-induced nausea and vomiting.</p>

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Sustained antiemetic efficacy of fosnetupitant versus aprepitant in carboplatin-based chemotherapy: a retrospective observational study

  • 期刊论文

  • 发表日期：

    2025年12月9日

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  • Hiroshi Inano,
  • Yoshihito Morimoto,
  • Atsushi Kawamura,
  • Taichi Ikegami,
  • Tomoki Niizuma,
  • Kanata Kitagawa,
  • Rie Usami,
  • Kozue Nakagomi,
  • Yuri Anzo,
  • Misaki Uchikawa,
  • Haruki Yamamoto,
  • Aiko Shono,
  • Kazuhiro Watanabe,
  • Katsuya Otori

摘要

Background

Carboplatin (CBDCA) is highly emetogenic when administered at an area under the curve (AUC) ≥ 4, requiring triple antiemetic therapy, including an NK1 receptor antagonist (NK1 RA). Fosnetupitant (F-NTP), a long-acting NK1 RA, may provide sustained receptor occupancy; however, its direct comparisons with aprepitant (APR) in CBDCA-based regimens between 0 and 168 h remain lacking. We aimed to evaluate the antiemetic efficacy of F-NTP versus APR during 1 week following chemotherapy.

Methods

This retrospective single-center observational study included patients with cancer receiving CBDCA (AUC ≥ 4)-based regimens. Propensity score matching was performed using clinical factors. The primary endpoint was the complete response (CR; no emesis or rescue medication) rate between 0 and 168 h. The secondary endpoints included phase-specific CR rates, time to treatment failure (TTF), and adverse events (AEs).

Results

After matching, 242 patients were included in each group. The overall CR rate at 0–168 h was significantly higher with F-NTP (83.5%) than with APR (69.4%) (p < 0.001). F-NTP significantly prolonged TTF (hazard ratio = 0.48, 95% confidence interval: 0.33–0.71, p < 0.001). The multivariate analysis revealed female sex, younger age, and high CBDCA dose as significant risk factors for non-CR, while F-NTP use was a protective factor. AEs did not differ significantly between the groups and were mostly Grade 1.

Conclusion

F-NTP demonstrated superior antiemetic efficacy to that of APR in CBDCA-based regimens, particularly maintaining higher CR rates through the acute and delayed phases. F-NTP was also well tolerated, supporting its potential as a strong prophylactic agent for preventing chemotherapy-induced nausea and vomiting.