Common Anti-Nausea Pill Could Be Game-Changer for Hard-to-Treat Breast Cancers

A recent study has identified a link between a widely used anti-nausea drug and improved outcomes for women with early-stage breast cancer, with especially notable effects in those with triple negative breast cancer, the Journal of the National Cancer Institute reported.

Researchers from Monash University and the Norwegian Institute of Public Health analyzed data from the Cancer Registry of Norway, focusing on 13,811 women diagnosed with early-stage breast cancer between 2008 and 2020. All participants had undergone chemotherapy and were given medications to manage chemotherapy-induced nausea and vomiting.

Among women undergoing chemotherapy for breast cancer, those who received the anti-nausea drug aprepitant had an 11 percent lower risk of cancer recurrence and a 17 percent lower risk of dying from breast cancer over a 10-year follow-up period. In contrast, the use of other types of anti-nausea medications showed no link to improved cancer outcomes.

The findings were especially significant in women with triple negative breast cancer. In this group, aprepitant use was associated with a 34 percent lower risk of recurrence and a 39 percent lower risk of death.

Senior author of the study, Dr. Aeson Chang from the Monash Institute of Pharmaceutical Sciences (MIPS), said triple negative breast cancer is typically an aggressive cancer with poorer clinical outcomes compared with other breast cancer subtypes diagnosed at the same stage.

“Because of the nature of triple negative breast cancer, there are fewer targeted treatment options, and therefore repurposing of drugs with well-established safety profiles is an attractive path for rapid translation to improve cancer treatment and outcomes,” Dr. Chang said.

“Very little is known about how and why aprepitant use could impact long-term survival outcomes in women with breast cancer, which is why we wanted to examine whether its use at the time of chemotherapy treatment may be linked with survival outcomes in a large population-based cohort of women with early-stage breast cancer.”

Co-senior author Professor Erica Sloan, also from MIPS, said the team was excited to find such a significant association between aprepitant use and improved survival in women with triple negative breast cancer.

“Triple negative breast cancer can be especially challenging to treat and with around 3,000 new cases diagnosed each year in Australia, new treatment pathways are important. We believe further studies are urgently needed to evaluate the effect of aprepitant in preventing cancer relapse and potentially inform new anti-nausea prescribing guidelines down the track,” Professor Sloan said.

Nausea and vomiting caused by chemotherapy are common side effects for patients with early-stage breast cancer, impacting as many as 60 percent of those undergoing systemic treatment. Current guidelines advise prescribing aprepitant only for individuals receiving chemotherapy regimens that carry a high risk of triggering these symptoms.

Dr. Chang said the findings of this study suggest that expanding the use of aprepitant as a routine antiemetic regimen during chemotherapy treatment warrants further exploration.

“Generally speaking, when aprepitant is taken, it’s during the first three days of chemotherapy treatment. Given the association between aprepitant and improved cancer outcomes uncovered in this study, it has led us to wonder if even greater survival would be observed if longer-term use of aprepitant was factored into the patients dosing schedule,” Dr. Chang said.

The study’s first author and pharmacoepidemiologist at the Cancer Registry of Norway within the Norwegian Institute of Public Health, Dr. Edoardo Botteri, said the use of retrospective data from such a large cohort of patients has allowed them to provide the first evidence of a relationship between aprepitant and cancer out comes in women with breast cancer.

“This is a very exciting finding! Since this is the first observational study, further observational studies and clinical trials are required to confirm our findings in breast cancer and likely in other cancer types,” Dr. Botteri said.

“Given what this study has uncovered, it’s essential these links are further explored – we now need to better understand why these associations have presented themselves and from there we can look at what this might mean for prescribing and dosing regimens in the future.”

Dr. Botteri has been collaborating with Monash University for several years. Together, he, Dr. Chang, and Professor Sloan have investigated associations between commonly prescribed medications and breast cancer outcomes.

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