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Title: Use of long term aprepitant as a treatment for refractory nausea following oesophageal stent insertion - a case report
Authors: Shoulder, Richard ;Stiel, Hilary ;Taylor, J.
Affliation: Central Coast Local Health District
Gosford Hospital
Issue Date: Dec-2021
Source: 36(2):395-398
Journal title: Palliative medicine
Department: Palliative Care
Abstract: BACKGROUND: Aprepitant, a substance P neurokinin-1 receptor antagonist, is licenced for the prevention of acute and delayed nausea and vomiting associated with highly and moderately emetogenic cancer chemotherapy. CASE: A 33 year-old male with metastatic gastro-oesophageal cancer had multiple admissions for refractory nausea and vomiting following insertion of an oesophageal stent. ACTION: Mechanical issues with the stent, stent removal and central causes were excluded. Multiple anti-emetic agents were trialled in combination and with varying routes of administration without significant symptomatic improvement. FORMULATION: A trial of aprepitant was proposed as an off-licence therapy. OUTCOME: One hundred sixty-five milligrammes of aprepitant was given orally every 3 days and then up titrated to once daily with significant symptomatic improvement enabling the patient to tolerate an oral diet. The patient remained stable at 12 weeks and has been accepted into two clinical trials for potential further cancer treatment. LESSONS: Aprepitant can be effective in refractory nausea and vomiting outside of emetogenic chemotherapy and safely used as a chronic treatment. The prevalence of refractory nausea and vomiting as a rare adverse outcome post-oesophageal stent insertion should be studied. WHAT NOW? Further research of neurokinin-1 inhibitors for indications other than chemotherapy-induced nausea and vomiting is indicated.
DOI: 10.1177/02692163211065276
ISSN: 0269-2163
Publicaton type: Journal Article
Keywords: Cancer
Drug Therapy
Study or Trial: Case Series and Case Reports
Appears in Collections:Oncology / Cancer

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