Antiemetic Prophylaxis with Granisetron and Fosaprepitant during Moderate and High Emetogenic Chemotherapy in Pediatric Patients

Background Pediatric patients that undergo chemotherapy and hematopoietic stem cell transplantation regularly experience chemotherapy-induced nausea and vomiting (CINV), which represents a major impairment of the patients9 quality of life. Antiemetic prophylaxis is thus an important factor in cancer therapy management. Risk for CINV is defined by >30-60% in moderate and by >60% in high emetogenic therapy. International guidelines recommend antiemetic prophylaxis with a combination of corticosteroids, 5-HT3R-antagonists (5-hydroxytryptamine-3 receptor) and NK1R-antagonists (neurokinin-1 receptor). Especially the water-soluble NK1R-antagonist fosaprepitant has shown favorable results in adult patients when used in a combination prophylaxis with the 5-HT3R-antagonist granisetron. This is the first comparative analysis to assess the efficacy and safety of a combination of intravenous fosaprepitant, granisetron and dexamethasone versus a standard prophylaxis regimen with granisetron and dexamethasone alone in 86 pediatric patients. Results In this retrospective single-center chart analysis, a total of 86 pediatric patients with a median age of 7 years (2-17 years) were enrolled between 2015 and 2017. The patients received either antiemetic prophylaxis with intravenous infusion ( Both prophylaxis regimens were similarly safe and not significantly different (p>0.05) with respect to clinical or laboratory drug-related adverse events. Discontinuation of the antiemetic medication was not indicated for any of the patients of the CG or FG. Percentages of patients experiencing vomiting was significantly lower in the FG, both in the acute CINV phase (p Conclusion In conclusion, additional single-dose fosaprepitant in combination with the standard antiemetic regimen with granisetron and dexamethasone proved to be safe and effective as antiemetic prophylaxis in pediatric patients receiving moderate or high emetogenic therapy. Observed drug-related side effects were similar in both study groups. Efficacy of a triple-prophylaxis with the NK1R-antagonists fosaprepitant in combination with the 5-HT3R-antagonist granisetron and the corticosteroid dexamethasone was significantly superior when compared to a prophylaxis regimen with granisetron plus dexamethasone alone. Acknowledgements This study was supported by the Stefan-Morsch-Stiftung, Birkenfeld, Germany. Disclosures Handgretinger: Miltenyi Biotec GmbH: Patents & Royalties, Research Funding.