Efficacy of Aprepitant for Nausea and Vomiting Induced by CHOP/R-CHOP or Pola-R-CHP Chemotherapy

Background/Aim: Although neurokinin-1 receptor antagonists, such as aprepitant, are recommended for the prevention of chemotherapy-induced nausea and vomiting (CINV) in highly emetogenic chemotherapy, their effectiveness in regimens using cyclophosphamide, doxorubicin, vincristine and prednisolone (CHOP), rituximab combined with CHOP (R-CHOP), and polatuzumab vedotin plus rituximab, cyclophosphamide, doxorubicin and prednisone (Pola-R-CHP) remains unclear. This study aimed to determine whether triplet antiemetic therapy (aprepitant and granisetron and prednisolone) is superior to doublet antiemetic therapy (granisetron and prednisolone) in preventing CINV associated with CHOP/R-CHOP and Pola-R-CHP therapy. Patients and Methods: This retrospective study included 57 patients with non-Hodgkin lymphoma (NHL) who received CHOP/R-CHOP or Pola-R-CHP therapy between April 2017 and December 2024. We evaluated the complete response (CR) rate, defined as no vomiting and no use of rescue medication, and time to treatment failure, defined as the time from initiation of chemotherapy to the first emetic episode or use of rescue medication following the first cycle of chemotherapy. Multivariate analysis was performed to identify risk factors for non-CR. Results: The CR rate during the overall phase (0-120 h) did not differ significantly between the triplet and doublet antiemetic groups (82.5% and 76.5%, respectively; p=0.717). Time to treatment failure was also not significantly different between the two groups. Multivariate analysis identified female sex as a risk factor for non-CR. Conclusion: Doublet antiemetic therapy may be an appropriate treatment option for patients with NHL receiving CHOP/R-CHOP and Pola-R-CHP therapy. Furthermore, a risk-based approach may be more suitable than routine triplet prophylaxis for these regimens.