Anti-Nausea Drug During Chemo Boosts Breast Cancer Survival

A medication commonly used to prevent nausea and vomiting during chemotherapy may help some women with breast cancer live longer, according to a new study.  

The drug, called aprepitant, is typically taken for the first three days of each round of chemotherapy and is used in combination with other anti-nausea medications. 

Researchers found that women with hormone receptor-negative breast cancer (both triple-negative, and hormone receptor-negative but HER2-positive) who took aprepitant were less likely to die from any cause during the follow-up period. The biggest benefit was in women with triple-negative breast cancer. The longer the women took aprepitant, the more likely they were to survive during the follow-up period.

“If I were a patient, I would want it on board,” says Winson Cheung, an oncologist at the University of Calgary who was not involved in the study.

The study analyzed data from nearly 14,000 women in Norway who received chemotherapy for early breast cancer. It looked at whether the women took one of five anti-nausea medications and tracked their survival outcomes for up to 13 years after diagnosis.

Women with hormone receptor-negative breast cancer who took aprepitant were 36% less likely to die from cancer during the follow-up period, and women with triple-negative breast cancer were 39% less likely.

Researchers did not see the same benefit from the four other anti-nausea medications — ondansetron, dexamethasone, metoclopramide, and a combination of netupitant and palonosetron.

There are two main theories why aprepitant may increase cancer survival.

First, aprepitant may be so good at preventing nausea and vomiting that it allows people to handle longer, stronger, and more rounds of chemo, Cheung says.

People may also be better able to stick to their aprepitant regimen since it’s only three days, compared to other anti-nausea medications that may need to be taken for longer periods of time.

Another explanation is that aprepitant itself may slow cancer growth. Nearly 60 lab studies have found that the medication can slow the growth of 22 cancers. Other cell studies suggest that aprepitant may reduce metastasis. These effects may be due to how aprepitant alters cell signaling. But these findings have only been in laboratory studies, so researchers can’t be sure if aprepitant directly slows cancer growth in people.

“I don't care what the reason is, if people are living longer,” says Richard Kast, a general practitioner who researches cancer medications. “And I think it will prolong survival.”

Side effects from aprepitant aren’t common, Kast says. But it can interact with some other medicines, so not everyone can take it.

As this was a retrospective study, the results will remain inconclusive in the minds of some practitioners. But both Cheung and Kast think that people on chemotherapy should consider taking aprepitant. The major roadblock is that it can be expensive, and not all insurance covers it.

Even when insurance does cover it, oncologists may not want to add another medication on top of an already full treatment plan. But Cheung says that even mild nausea can affect quality of life, so he encourages people to ask for it. He also hopes that this new study will convince more doctors to prescribe it.