Antiemetic medication efficacy during EPOCH and R-EPOCH treatment.

INTRODUCTION: This study aims to determine the adequacy of current institutional standard practice for CINV prophylaxis for EPOCH and R-EPOCH at The Ohio State University James Cancer Hospital. METHODS: Single-center, retrospective analysis was performed including all patients receiving EPOCH or R-EPOCH chemotherapy for Non-Hodgkin's lymphomas from 1/1/2012 to 6/30/2017. The primary endpoint was rate of CINV events, which included usage of more than 50 percent of available doses of breakthrough antiemetics while inpatient, hospitalization due to CINV or related complications, or adjustments made to the CINV prophylactic or breakthrough regimen during current or subsequent cycles. Secondary endpoints included determining prescriber adherence to institutional standard CINV prophylaxis, characterization of adjustments to the antiemetic regimen following the incidence of CINV, and identification of high-risk patients that may benefit from additional CINV prophylaxis. RESULTS: Of 111 patients, 54 (48.6%) experienced CINV events with any cycle of EPOCH or R-EPOCH chemotherapy. Of those patients, 17 (31.5%) received institutional standard CINV prophylaxis at baseline, 8 (14.8%) received additional scheduled antiemetics, and 26 (48.1%) were prescribed additional breakthrough antiemetics with their first cycle of EPOCH or R-EPOCH. Younger age, diagnosis of anxiety, and previous susceptibility to nausea were significantly associated with CINV events. CONCLUSION: This study illustrates the inadequacy of current institutional standard for CINV prophylaxis for patients receiving EPOCH and R-EPOCH, highly emetogenic chemotherapy regimens. With nearly half of included patients experiencing CINV events, and most initially receiving more than our standard prophylaxis, changes to our standard antiemetics used with this chemotherapy regimen are needed.

Updated report on incidence of infusion-site reactions associated with peripheral intravenous administration of fosaprepitant.

PURPOSE: Fosaprepitant (Emend®) is an antiemetic frequently used for the prevention of chemotherapy-induced nausea and vomiting. We previously documented an overall 28.7% incidence of infusion-site reactions in patients receiving fosaprepitant via peripheral venous access. These data resulted in a practice change within our institution; fosaprepitant is administered in more dilute concentrations over 30 min to prevent these adverse events. This retrospective study explored the impact of this practice change on the incidence of infusion-site reactions. METHODS: Medical records of patients with cancer receiving intravenous fosaprepitant through a peripheral intravenous line were reviewed. The primary objective of this study was to compare the incidence of infusion-site reactions before the practice change to the incidence after the practice change. Data collection included demographics, fosaprepitant infusion information, and grading of reactions. RESULTS: Between September 2013 and December of 2013, charts of 122 patients receiving intravenous fosaprepitant through a peripheral line at the The Arthur G. James Cancer Hospital at The Ohio State University were reviewed. We found a 5.74% incidence of infusion-site reactions which is significantly lower than the prechange incidence of 28.7% (p < 0.001). CONCLUSIONS: Infusion-site reactions were significantly reduced when fosaprepitant was diluted to 150 mg/250 ml and infused over 30 min. We recommend oncology pharmacists consider using the more dilute fosaprepitant preparation and 30 min infusion duration when administering via a peripheral intravenous line to improve patient tolerance.

Biweekly gemcitabine and low-dose cisplatin in the treatment of locally advanced or metastatic pancreatic cancer patients: a single institute experience.

Gemcitabine in combination with low-dose cisplatin has shown promising activity in pancreatic cancer with manageable toxicities. The purpose of this study is to assess the activity of a combination of gemcitabine and low-dose cisplatin in the first-line treatment of metastatic and locally advanced pancreatic cancer patients. We conducted a retrospective analysis of all patients diagnosed with metastatic and locally advanced pancreatic cancer who received a combination of gemcitabine and cisplatin in the first-line setting. Patients with baseline cytopenias and elevated liver function tests were included. Patients received cisplatin at 20 mg per square meter followed by gemcitabine at a dose of 1000 mg per square meter at fixed dose rate every 2 weeks. Patients were treated until disease progression or unacceptable toxicities. A total of 58 patients were included in the analysis. The median progression-free survival was 4.4 months [95 % confidence interval (CI) 3.6-6.4], and median overall survival was 6.7 months (95 % CI 4.4-10.9). Thirty-eight patients (66 %) experienced at least one grade 3 or 4 toxicity. The most common grade 3 or 4 toxicity was hematologic toxicity (25 patients, 43 %). Biweekly fixed dose rate gemcitabine combined with low-dose cisplatin shows interesting activity in advanced pancreatic cancer. This regimen is an acceptable alternative for patients ineligible for gemcitabine plus nab-paclitaxel (i.e., those with elevated bilirubin at baseline) or clinical trials. Additionally, this regimen should be considered as a first-line option for those patients with breast cancer susceptibility gene mutations (BRCA1 and/or BRCA2).

Incidence of infusion-site reactions associated with peripheral intravenous administration of fosaprepitant.

PURPOSE: Fosaprepitant is known to cause infusion-site reactions. However, there is limited data regarding these reactions including the effect of peripheral intravenous administration or other potential factors on their incidence. This single-institution retrospective study was undertaken to investigate the incidence of infusion-site reactions with single-dose intravenous (IV) fosaprepitant when given through a peripheral line prior to administration of chemotherapy. Risk factors for the development of infusion-site reactions with fosaprepitant were also explored. METHODS: Medical records of patients with cancer receiving IV fosaprepitant through a peripheral line were reviewed. The primary objective of this study was to estimate the incidence of infusion-site reactions at our institution. Data collection included demographics, fosaprepitant infusion information, and grading of reactions. RESULTS: We found a 15 % incidence of infusion-site reactions among all peripherally administered doses of fosaprepitant. The 50 reactions occurred in 43 unique patients representing an incidence per patient of 28.7 % (43/150; 95 % confidence interval (CI) 21.6-36.6). Factors found to be associated with infusion-site reactions included age [odds ratio (OR) 0.97 (95 % CI 0.94-0.99)], location of IV line [OR forearm vs. hand 0.41 (95 % CI 0.20-0.85); OR antecubital fossa vs. hand 0.31 (95 % CI 0.11-0.87)], and simultaneous maintenance IV fluid rate ≥100 mL/h during fosaprepitant infusion [OR 0.19 (95 % CI 0.08-0.44)]. CONCLUSIONS: The incidence of infusion-site reactions with peripherally administered fosaprepitant as seen in this study is higher than that reported in the package insert. Risk factors for developing infusion-site reactions in our patient population include age, location of IV line, and simultaneous maintenance IV fluid rate of <100 mL/h.