Peripheral Neuropathy in Non-Hodgkin_x0019_s Lymphoma Patients Receiving Vincristine with and without Aprepitant, Fosaprepitant Jessi K. Edwards, John Bossaer, Paul O. Lewis, Ashley Sant Johnson City Medical Center - Johnson City, TN
Background/Purpose: Chemotherapy-induced peripheral neuropathy (CIPN) is a common adverse effect associated with vincristine chemotherapy. In 2014, Naoto Okada and investigators discovered an increased incidence of CIPN onset during the first cycle of chemotherapy when aprepitant, a NK-1 antagonist, was given with vincristine. The purpose of this study was to investigate if there is a clinically significant drug interaction between vincristine and aprepitant/fosaprepitant resulting in early-onset CIPN. Secondarily, this study investigated the cumulative rate of CIPN throughout the entire treatment course.
Methodology: This IRB approved, single-center, retrospective cohort chart review was performed at Johnson City Medical Center and evaluated adults who received R-CHOP or similar chemotherapy for the treatment of Non-Hodgkin_x0019_s Lymphoma between July 1, 2010 through June 30, 2018. Data collected included demographic information, aprepitant/fosaprepitant use, chemotherapy regimen and dose, neuropathy onset time, neuropathy grade, pertinent laboratory values, potential confounding comorbidities, and concurrent use of additional CYP3A4 inhibitors. Early-onset CIPN was defined as neuropathy developing during the first cycle of chemotherapy. Neuropathy rates were analyzed by one-tailed chi-square.
Results: Of the 115 subjects that met inclusion criteria, CIPN rates in the first cycle appeared elevated in subjects with concurrent NK-1 antagonist use as compared to those without (26.7% vs 22.7%; P=0.67). The secondary endpoint of overall neuropathy rates was higher with concurrent NK-1 antagonist use (56% vs 36%; P=0.039). The overall median time to neuropathy onset was 25.5 days.
Conclusions: Concurrent use of aprepitant or fosaprepitant with vincristine-based chemotherapy does not increase the rate of CIPN in the first cycle but appears to increase cumulative rates of CIPN.
Presentation Objective: Identify if there is a clinically significant drug interaction between vincristine and aprepitant or fosaprepitant resulting in early-onset chemotherapy-induced peripheral neuropathy.
Self-Assessment: Does concomitant use of aprepitant or fosaprepitant with vincristine chemotherapy result in early-onset peripheral neuropathy?
