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Fosaprepitant Versus Aprepitant in the Prevention of Chemotherapy Induced Nausea and Vomiting

This study has been completed.
Merck Sharp & Dohme Corp.
Information provided by (Responsible Party):
Gynecologic Oncology Associates Identifier:
First received: September 7, 2011
Last updated: February 24, 2017
Last verified: May 2015
Nausea and vomiting are two of the more concerning adverse outcomes associated with chemotherapy in the treatment of gynecologic malignancies. In fact, nearly 90% of cancer patients develop chemotherapy induced nausea and vomiting (CINV) following treatment with carboplatin and paclitaxel. The successful control of chemotherapy induced nausea and vomiting (CINV) is thus, of paramount importance in ensuring optimal treatment and sustaining a cancer patient's quality of life.

Condition Intervention Phase
Ovarian Cancer
Uterine Cancer
Drug: fosaprepitant
Drug: aprepitant
Other: Oral Placebo
Other: IV placebo
Phase 4

Study Type: Interventional
Study Design: Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Participant, Investigator
Primary Purpose: Treatment
Official Title: A Phase IV Study Comparing the Efficacy of Fosaprepitant to Aprepitant for Chemotherapy Induced Nausea and Vomiting in Patients Treated for Gynecological Cancer

Resource links provided by NLM:

Further study details as provided by Gynecologic Oncology Associates:

Primary Outcome Measures:
  • Overall Complete Response Rate [ Time Frame: 13 months ]
    no emetic episodes or rescue therapy following the initiation of chemotherapy

Secondary Outcome Measures:
  • Impact on Daily Living Activities [ Time Frame: 13 months ]
    Proportion of patients reporting no impact on daily living activities following initiation of chemotherapy

Enrollment: 20
Study Start Date: September 2011
Study Completion Date: March 2015
Primary Completion Date: March 2015 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Active Comparator: Fosaprepitant
Fosaprepitant for Injection 150 mg is administered intravenously on Day 1 only as an infusion over 20-30 minutes initiated approximately 30 minutes prior to chemotherapy. Oral Placebo given on days 1-3
Drug: fosaprepitant
Fosaprepitant for Injection 150 mg is administered intravenously on Day 1 only as an infusion over 20-30 minutes initiated approximately 30 minutes prior to chemotherapy. Patient will receive standard pre-medications
Other Name: Emend IV
Other: Oral Placebo
One pill administered on days 1-3 in conjunction with Fosaprepitant.
Active Comparator: Aprepitant
Aprepitant 125 mg orally 1 hour prior to chemotherapy treatment (Day 1) and 80 mg orally once daily in the morning on Days 2 and 3. 100 cc of IV placebo administered on day 1
Drug: aprepitant
Aprepitant 125 mg orally 1 hour prior to chemotherapy treatment (Day 1) and 80 mg orally once daily in the morning on Days 2 and 3. patient will receive standard pre-medications
Other Name: Emend
Other: IV placebo
100 cc of IV placebo administered on day in conjunction with Aprepitant
Other Name: Normal Saline

Detailed Description:
Studies have indicated that oral and intravenous anti-emetics are equivalent with regard to efficacy; when evaluating cost and convenience, the intravenous route may be preferable. Fosaprepitant, a water-soluble phosphoryl prodrug for aprepitant, is converted to aprepitant via phosphatases following intravenous administration. Given the rapid conversion of fosaprepitant to the active form (i.e., aprepitant), the two medications appear to provide a similarly effective antiemetic impact. Clinical reports have additionally suggested that fosaprepitant could be appropriate as an intravenous alternative to the oral aprepitant.

Ages Eligible for Study:   18 Years and older   (Adult, Senior)
Sexes Eligible for Study:   Female
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • Female Gender
  • Age > 18 years
  • A histologic diagnosis of stage III/IV gynecologic cancer (e.g., epithelial ovarian, fallopian tube, peritoneal cancer and uterine cancer).
  • Subjects who will be treated with Taxol and Carboplatin as standard of care for a newly diagnosed gynecological cancer.
  • Adequate bone marrow function as demonstrated by:

Absolute neutrophil count (ANC) > 1,500/μL; platelet count > 100,000/μL; and hemoglobin > 9 g/dL • Adequate renal function demonstrated by: Serum creatinine of < 1.5 x ULN or 24-hr measured urine creatinine clearance > 60 mL/min for patients with serum creatinine > 1.5 x ULN

• Adequate hepatic function demonstrated by: Total bilirubin of < 1.5 x ULN AST or ALT ≤ 2.5 x ULN

  • EGOG status of < 2: Postoperatively, patients demonstrate an ECOG score of 1 or 2. However, during the first cycle of chemotherapy, the patients' performance status improves to < 1.
  • Projected life expectancy of at least 3 months
  • Ability to comply with the visit schedule and assessments required by the protocol
  • Negative pregnancy test for women of childbearing potential
  • Signed, IRB approved informed consent and HIPPA consent

Exclusion Criteria:

  • Subjects with a diagnosis of epithelial ovarian, fallopian tube or peritoneal cancers of low malignant potential (borderline carcinomas) are not eligible.
  • Allergy or intolerance to 5HT3 or NK-1 antagonists and dexamethasone
  • An episode of vomiting or retching within 24 hours before the start of the initial treatment with chemotherapy
  • Subjects with concomitant malignancy or a previous malignancy within the past three (3) years (except non-melanoma skin cancer)
  • Current, recent (within 4 weeks of the first infusion of this study), or planned participation in an experimental drug study.
  • Screening clinical laboratory values of:

ANC of <1500/DL Platelet count of <100,000/µL Total bilirubin of *1.5 mg/dL x ULN SGOT (AST) or SGPT (ALT) * 2.5 x ULN Serum creatinine of * 1.5 mg/dL Hemoglobin of * 9 gm/dL (may be transfused or receive a colony stimulating factor to maintain or exceed this level)

  • EGOG status of > 2
  • Gastrointestinal obstruction or an active peptic ulcer
  • Patients who are pregnant or breast feeding because aprepitant may be harmful to the developing fetus and newborn
  • Known active HIV and viral hepatitis infections
  • Inability to comply with study
  • New York Heart Association (NYHA) Grade II or greater congestive heart failure (see Appendix D)
  Contacts and Locations
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Please refer to this study by its identifier: NCT01432015

United States, California
Gynecologic Oncology Associates
Newport Beach, California, United States, 92663
Sponsors and Collaborators
Gynecologic Oncology Associates
Merck Sharp & Dohme Corp.
Principal Investigator: John P Micha, MD Gynecologic Oncology Associates
  More Information

Responsible Party: Gynecologic Oncology Associates Identifier: NCT01432015     History of Changes
Other Study ID Numbers: GOA-NVM1
Study First Received: September 7, 2011
Results First Received: April 29, 2015
Last Updated: February 24, 2017
Individual Participant Data  
Plan to Share IPD: No

Keywords provided by Gynecologic Oncology Associates:
gynecologic cancer

Additional relevant MeSH terms:
Uterine Neoplasms
Signs and Symptoms, Digestive
Signs and Symptoms
Genital Neoplasms, Female
Urogenital Neoplasms
Neoplasms by Site
Uterine Diseases
Genital Diseases, Female
Autonomic Agents
Peripheral Nervous System Agents
Physiological Effects of Drugs
Gastrointestinal Agents
Neurokinin-1 Receptor Antagonists
Neurotransmitter Agents
Molecular Mechanisms of Pharmacological Action processed this record on May 25, 2017