Impact of pre-chemotherapy food intake on chemotherapy-induced nausea and vomiting in patients with early breast cancer: a subanalysis of the randomized SUCCESS C trial

Purpose Chemotherapy-induced nausea and vomiting (CINV) remains a challenging side effect, significantly impacting patients' quality of life [1–3]. Knowledge of eating behaviour’s influence on CINV is still limited. This study improves the understanding of CINV by investigating the impact of pre-chemotherapy food intake within the randomized Phase III SUCCESS C trial. Methods The SUCCESS C trial (NCT00847444), enrolled ,463 women with early-stage, HER2-negative breast cancer, receiving either three cycles of 5-fluorouracil (500 mg/m 2 ), epirubicin (100 mg/m 2 ), and cyclophosphamide (500 mg/m 2 ) followed by three cycles of docetaxel (100 mg/m 2 ) every 3 weeks (FEC), or six cycles of docetaxel (75 mg/m 2 ) and cyclophosphamide (600 mg/m 2 ) (TC). The present analysis included patients with completed CINV diary with hourly documentation over 5 days post-chemotherapy. Results CINV diary data during chemotherapy cycles 1–3 were available for 1582 patients, of whom 814 received FEC and 768 TC. Patient characteristics between chemotherapy arms were comparable. For FEC, pre-chemotherapy eating behaviour had a significant impact on nausea-free survival (NFS) in cycle 1 ( p = 0.04) and on emesis-free survival (EFS) in cycle 2 ( p = 0.02). For TC, no effect on NFS, but a significant effect on EFS ( p = 0.04 in cycle 1; p < 0.01 in cycle 2), was observed. Median EFS was approximately 120 h for all cycles and treatments. Conclusion This analysis demonstrates in both regimens less emesis, and for FEC less nausea, of patients with pre-chemotherapy food intake. The effect was most pronounced during the first 24 h after chemotherapy administration. Thus, eating behaviour influences CINV outcomes and warrants further evaluation.