Amisulpride in the prevention of nausea and vomiting induced by cisplatin-based chemotherapy: a dose-escalation study
The purpose of this study was to investigate the antiemetic effect of the dopamine D2- and dopamine D3-receptor antagonist, amisulpride, in patients receiving cisplatin-based chemotherapy.
This dose-finding, non-comparative study investigated the antiemetic effect and safety of increasing doses (2.5, 7.5 and 20 mg) of amisulpride against acute nausea and vomiting in the period 0–24 h after initiation of cisplatin-based chemotherapy. The 20 mg dose was also investigated in combination with the 5-HT3-receptor antagonist, ondansetron. The primary parameter was complete response (0–24 h), defined as no emesis and no need for rescue antiemetics. Secondary parameters were number of emetic episodes, severity of nausea and time to first emetic episode and start of nausea.
A total of 51 patients were enrolled and evaluable. None of the 10 patients in the 2.5 and 7.5 mg groups obtained a CR. In the 20 mg monotherapy cohort, two of the 18 subjects (11%) had a CR, 3/18 (17%) had no emesis and 12/18 (67%) had no significant nausea. Seven subjects (39%) had no nausea at all (a VAS score < 5 mm). In the combination (ondansetron plus amisulpride) cohort, 19/23 (83%; 90% confidence interval: 65–94%) had a CR and 14/23 (61%) had no nausea at all.
Amisulpride has antiemetic effect against cisplatin-induced acute nausea and vomiting. The effect against nausea is of particular interest. Randomised studies are warranted to further explore the effect and safety of amisulpride.
KeywordsCisplatin Amisulpride Nausea Vomiting Chemotherapy Dopamine antagonist
Compliance with ethical standards
The study was approved by the National Health Authorities and properly constituted Ethics Committees in Denmark and the UK and was conducted in accordance with the principles of Good Clinical Practice. All subjects gave written, informed consent. The study was registered on clintrials.gov with reference no. NCT01303978.
Conflict of interest
The study was sponsored by Acacia Pharma Ltd. The investigators had access to all data.
The journal is allowed to review the data if requested.
Jørn Herrstedt reported advisory board activity (Tesaro) and remuneration (SOBI).
Alex Molassiotis has received grants or honoraria from MSD, Merck, Helsinn, Tesaro, Norgine and Acacia Pharma.
Gabriel Fox is an employee of Acacia.
The other authors reported no conflicts of interest.
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