Assessing the impact of aprepitant on response to dose-intensive cyclophosphamide, etoposide, and cisplatin (DICEP).

This article examines the impact of aprepitant, an antiemetic drug, on response rates to dose-intensive cyclophosphamide, etoposide, and cisplatin (DICEP) chemotherapy in patients with relapsed or refractory Hodgkin lymphoma (HL) and diffuse large B-cell lymphoma (DLBCL) undergoing stem cell transplant. A retrospective review of 218 patients treated at the Foothills Medical Centre in Calgary, Canada, found no significant difference in overall response rates, progression-free survival, or stem cell mobilization between those who received aprepitant and those who did not. Despite pharmacokinetic concerns that aprepitant’s inhibition of cytochrome P450 3A4 (CYP 3A4) might reduce cyclophosphamide activation, clinical outcomes were similar, supporting the use of aprepitant for chemotherapy-induced nausea and vomiting (CINV) in this setting. The study suggests that aprepitant should be strongly considered as part of standard antiemetic therapy during DICEP chemotherapy in transplant patients, though larger studies are recommended to confirm these findings.