Evaluation of Antiemetics Chosen by Patients and Antiemetic Effects in EC Therapy for Breast Cancer

We investigated which antiemetic treatment patients selected during epirubicin /cyclophosphamide (EC) therapy for breast cancer, and assessed the antiemetic efficacy of each treatment using the MASCC Antiemesis Tool (MAT) completed by the patients. After patients received an explanation of antiemetic treatments, including their pharmaceutical prices, they selected and used one of the following four treatments: granisetron+dexamethasone (A), granisetron+dexamethasone+aprepitant (B), palonosetron+dexamethasone (C), or palonosetron+dexamethasone +aprepitant (D). During the first cycle of EC therapy, 50 patients selected one of the four treatments, and morepatients selected Treatments B and C than others: Treatment A was selected by 9 patients (18%), B by 18 (36%), C by 17 (34%), and D by 6 (12%). A total of 198 antiemetic treatments were performed during four cycles of EC therapy: 27 treatments (13.6%) of Treatment A, 81 treatments (40.9%) of B, 62 treatments (31.3%) of C, and 28 treatments (14.1%) of D. Comparing results between Treatment B and C groups, antiemetic rates in acute and late-onset periods and complete response (CR) rates in acute and entire periods in Treatment B group were superior to those in Treatment C group. The results show that none of the treatments provided sufficient nausea control. Since the usefulness of aprepitant, a new antiemetic drug, was demonstrated, but the superiority of palonosetron to granisetron was not determined, and also taking the cost to the patient into consideration, a combination of aprepitant and dexamethasone with one selected 5-HT3 receptor antagonist is recommended.