A new study has found a commonly prescribed anti-nausea medication is associated with better prognosis for women with early-stage breast cancer, particularly triple negative breast cancer.
The research team, co-led by Monash University and the Norwegian Institute of Public Health, evaluated Cancer Registry of Norway data of 13,811 women diagnosed with early-stage breast cancer between 2008 and 2020 who received both chemotherapy and anti-nausea medications that are used to prevent chemotherapy-induced nausea and vomiting.
In women with breast cancer, the use of the anti-nausea medication aprepitant during chemotherapy treatment was linked to an overall 11 per cent lower risk of developing cancer recurrence and 17 per cent lower risk of breast cancer related death in the 10 year follow up period. When the researchers looked at anti-nausea medications of other drug classes, they found no association of their use with cancer outcomes.
Notably, when the researchers looked at breast cancer subtypes, they found the association between aprepitant and better survival outcomes was even stronger in women with triple negative breast cancer, with the study showing a potential 34 per cent reduced risk of cancer recurrence and 39 per cent reduced risk of death among this cohort.
Senior author of the Journal of the National Cancer Institute study, Dr Aeson Chang from the Monash Institute of Pharmaceutical Sciences (MIPS), said triple negative breast cancer is typically an aggressive cancer with poorer clinical outcomes compared with other breast cancer subtypes diagnosed at the same stage.
“Because of the nature of triple negative breast cancer, there are fewer targeted treatment options, and therefore repurposing of drugs with well established safety profiles is an attractive path for rapid translation to improve cancer treatment and outcomes,” Dr Chang said.
“Very little is known about how and why aprepitant use could impact long term survival outcomes in women with breast cancer, which is why we wanted to examine whether its use at the time of chemotherapy treatment may be linked with survival outcomes in a large population-based cohort of women with early-stage breast cancer.”
Co-senior author Professor Erica Sloan, also from MIPS, said the team were excited to find such a significant association between aprepitant use and improved survival in women with triple negative breast cancer.
“Triple negative breast cancer can be especially challenging to treat and with around 3,000 new cases diagnosed each year in Australia, new treatment pathways are important. We believe further studies are urgently needed to evaluate the effect of aprepitant in preventing cancer relapse and potentially inform new anti-nausea prescribing guidelines down the track,” Professor Sloan said.
Chemotherapy-induced nausea and vomiting is a prevalent side-effect of systemic chemotherapy in early-stage breast cancer patients, affecting up to 60 per cent of patients. Recent guidelines recommended the use of aprepitant only in patients treated with chemotherapy highly likely to induce vomiting and nausea.
Dr Chang said the findings of this study suggests that expanding the use of aprepitant as a routine antiemetic regimen during chemotherapy treatment warrants further exploration.
“Generally speaking, when aprepitant is taken it’s during the first three days of chemotherapy treatment. Given the association between aprepitant and improved cancer outcomes uncovered in this study, it has led us to wonder if even greater survival would be observed if longer term use of aprepitant was factored into the patients dosing schedule,” Dr Chang said.
The study’s first author and pharmacoepidemiologist at the Cancer Registry of Norway within the Norwegian Institute of Public Health, Dr Edoardo Botteri, said the use of retrospective data from such a large cohort of patients has allowed them to provide the first evidence of a relationship between aprepitant and cancer outcomes in women with breast cancer.
“This is a very exciting finding! Since this is the first observational study, further observational studies and clinical trials are required to confirm our findings in breast cancer and likely in other cancer types,” Dr Botteri said.
“Given what this study has uncovered, it’s essential these links are further explored - we now need to better understand why these associations have presented themselves and from there we can look at what this might mean for prescribing and dosing regimens in the future.”
The full study, titled Aprepitant use during chemotherapy and association with survival in women with early breast cancer can be found here.
DOI: https://doi.org/10.1093/jnci/djaf178
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