Cancer supportive care is a fundamental component of care for patients going through their cancer treatment journey. Research has shown that monitoring symptoms and introducing adequate intervention has a positive impact on overall survival.¹

Chemotherapy-induced nausea and vomiting (CINV) is a debilitating side effect that has a deleterious impact on patient’s quality of life with potential consequences on adherence to cancer treatment.

Historically, CINV has standardly been assessed in the first five days after chemotherapy. The acute phase corresponds to the first 24 hours while the delayed phase corresponds to the time between 25 and 120 hours.

CINV prevalence beyond 120 hours post-chemotherapy (long-delayed) has been recently evaluated showing that a substantial proportion of patients are experiencing CINV (in particular nausea) after this interval. The analysis showed that patients who experienced CINV on Days 4 and 5 following chemotherapy were at a greater risk of experiencing long-delayed CINV.

Treatment-related adverse events of antibody-drug conjugates in clinical trials: A systematic review and meta-analysis – PubMed (nih.gov)

At the upcoming European Society for Medical Oncology (ESMO) annual congress being held in Madrid from October 20-24, 2023, additional research on the prevalence of CINV beyond the delayed phase is being presented as a poster presentation as detailed below:

Title: Evaluation of Chemotherapy-induced Nausea and Vomiting Beyond the Delayed Phase: Results of a Survey of Healthcare Providers in Japan

Authors: Florian Scotté, Matti Aapro, Christina H. Ruhlmann, Yuri Takeuchi 

Poster 2078P

Date: Saturday, 21 October 2023

Antibody drug conjugates (ADCs) utilize novel technology combining the specificity of an antibody to a cytotoxic payload. The benefits of these new treatments suggest they have the potential to revolutionize the anticancer treatment landscape. Emerging data with ADCs, such as trastuzumab deruxtecan (T-DXd), suggests that vomiting and especially nausea are common side effects. These symptoms can occur for a longer time than with traditional chemotherapy^5-6, resulting in a persistent detrimental effect on patients’ quality of life. This evolving data suggests the need to optimize the prophylactic antiemetic regimen and monitor patients beyond the traditional delayed phase. Dr. Luca Licata is presenting the results of the first study of NEPA used for managing the AEs of T-DXd in 53 breast cancer patients as outlined below:

Title: Management of Trastuzumab Deruxtecan-related nausea and vomiting in real-world practice

Authors: L. Licata, G. Notini, L. Sica, G. Viale, S. Zambelli, A. Rognone, D. Aldrighetti, M. Piras, A. Nuccio, P. Zucchinelli, G. Bianchini

Poster 2090P

Date: Saturday, 21 October 2023

The introduction of new therapies is driving the evolution of the antiemetic treatment landscape and leading to the recognition that nausea and vomiting during the “long-delayed phase” as a distinct and new unmet need for patients.

References:

1. Basch E, Deal AM, Dueck AC, Scher HI, Kris MG, Hudis C, Schrag D. Overall Survival Results of a Trial Assessing Patient-Reported Outcomes for Symptom Monitoring During Routine Cancer Treatment. JAMA. 2017 Jul 11;318(2):197-198.
2. Zelek L, Navari R, Aapro M, Scotté F. Single-dose NEPA versus an aprepitant regimen for prevention of chemotherapy-induced nausea and vomiting in patients receiving moderately emetogenic chemotherapy. Cancer Med. 2023 Aug;12(15):15769-15776.
3. Hata A, Shiraishi Y, Inui N, Okada M, Morise M, Akiyoshi K, Takeda M, Watanabe Y, Sugawara S, Shinagawa N, Kubota K, Saeki T, Tamura T. Exploratory Analysis Comparing Fosnetupitant Versus Fosaprepitant for Prevention of Highly Emetogenic Chemotherapy-Induced Nausea and Vomiting (CINV): A Randomized, Double-Blind, Phase 3 Study (CONSOLE). Oncol Ther. 2022 Jun;10(1):253-262. 
4. Chow R, Yin LB, Baqri W, Huang R, Boldt G, Younus J, Lock M, Prsic E, Zimmermann C, Herrstedt J. Prevalence and predictors of long-delayed (> 120 h) chemotherapy-induced nausea and vomiting (CINV)-a systematic review and individual patient data meta-analysis. Support Care Cancer. 2023 Aug 3;31(8):505.
5. Rugo H, et al. ESMO Breast 2023; Oral Presentation #1850
6. Rugo HS, Bianchini G, Cortes J, Henning JW, Untch M. Optimizing treatment management of trastuzumab deruxtecan in clinical practice of breast cancer. ESMO Open. 2022 Aug;7(4):100553.