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Randomized Phase II Study of the Neurokinin 1 Receptor Antagonist CJ-11,974 in the Control of Cisplatin-Induced Emesis

From the St. Elizabeth's Medical Center, Boston, MA; Ochsner Cancer Center, New Orleans, LA; Central Arkansas Hematology and Oncology Clinic, Hot Springs, AR; Fairfax/Prince William Hematology-Oncology, PC, Alexandria, VA; Bennett Cancer Center, Stamford, CT; and Pfizer Central Research, Pfizer, Inc, Groton, CT.

Address reprint requests to Paul J. Hesketh, MD, Section of Medical Oncology, St. Elizabeth's Medical Center, 736 Cambridge St, Boston, MA 02135; Email phesketh{at}aol.com

PURPOSE: To determine the efficacy and safety of the neurokinin type 1 receptor antagonist CJ-11,974 for the control of high-dose cisplatin-induced emesis.

PATIENTS AND METHODS: A double-blind, randomized, phase II design with a group sequential stopping rule was used in this study. Sixty-one patients with cancer who were receiving cisplatin at a dose of at least 100 mg/m² for the first time were enrolled. All patients received granisetron 10 µg/kg and dexamethasone 20 mg intravenously 30 minutes before they were given cisplatin. Patients were randomly assigned to two groups: group 1 received CJ-11,974 100 mg, and group 2 received placebo orally 30 minutes before and 12 hours after cisplatin and then twice daily on days 2 through 5 after cisplatin. The primary end point was the percentage of patients who developed delayed emesis (emesis on the second to fifth days after cisplatin).

RESULTS: Thirty patients were enrolled in group 1, and 31 patients were enrolled in group 2. Fifty-eight patients were assessable for efficacy. Complete control of emesis (expressed as the percentage of patients who had no emesis) was as follows: day 1, 85.7% (group 1) and 66.7% (group 2) (P = .090); days 2 through 5, 67.8% (group 1) and 36.6% (group 2) (P = .0425, adjusted); days 1 through 5, 64.3% (group 1) and 30% (group 2) (P = .009). Patients in group 1 experienced significantly less nausea than patients in group 2 on day 1 (P = .024). Treatment was well tolerated in both groups.

CONCLUSION: We conclude from this exploratory phase II trial that CJ-11,974 is superior to placebo in controlling cisplatin-induced delayed emesis and may provide additive benefit in acute emesis and nausea control when combined with a 5-hydroxytryptamine-3 receptor antagonist and dexamethasone. Additional larger trials are indicated to confirm the clinical value of CJ-11,974.

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