Impact of Comorbidity on Antiemetic Efficacy in Patients with Esophageal Cancer Treated with Cisplatin-Based Chemotherapy: A Retrospective Study from Japan.

Introduction: Cancer patients often have comorbidities due to the aging population or various other factors. However, clinical trials typically exclude specific severe comorbidities, and no prior study has examined their impact on antiemetic efficacy. Our previous research suggested that antiemetic efficacy might be higher in patients with diabetes mellitus (DM) compared to those without DM because of cortisol and substance P. To further investigate this, the current study analyzed which comorbidities affected chemotherapy-induced nausea and vomiting in patients with esophageal cancer treated with cisplatin-based chemotherapy.

Methods: This retrospective study enrolled Japanese patients with esophageal cancer who received fluorouracil and cisplatin (FP) combination chemotherapy as their initial treatment. The primary endpoint was the total control (TC) rate during the first cycle, defined as no emetic episodes, no nausea, and no rescue medication use over the overall period (0-120 h) measured by patients' diary or medical staff interview. Univariate and multivariate logistic regression models were used to analyze the TC rate, including previously reported risk factors (age, sex, performance status, body mass index, cisplatin dose, and number of prophylactic antiemetic agents). Comorbidities showing significance in the univariate analysis were further assessed in the multivariate analysis. The significance level was set at 5%.

Results: Among the 285 eligible patients, the prevalence of comorbidities was as follows: hypertension (36.8%), DM (17.9%), cardiovascular disease (10.6%), and hyperlipidemia (9.5%). Multivariate analysis revealed a significantly higher TC rate during the overall period in patients with cardiovascular disease (50.0%) compared to those without one (32.5%) (adjusted odds ratio 0.455, 95% confidence interval 0.207-0.999, p = 0.0499).

Conclusions: Antiemetic regimen appeared to be more effective in patients with esophageal cancer and cardiovascular disease during the overall period when compared to patients without one. The clinical trial stratified by whether cardiovascular disease should be conducted in the further.