Effects of aprepitant use in patients (pts) with locally advanced squamous cell carcinoma of the head and neck (LA SCCHN) treated with high-dose cisplatin and radiation (RT).
Bibliographic record
Abstract
5593 Background: Aprepitant is an NK-1 antagonist that reduces delayed nausea and vomiting (N&V) in pts receiving high-dose (HD) cisplatin. Single-agent HD cisplatin 100 mg/m2 iv q3weeks × 3 doses concurrent with RT is a standard curative regimen for LA SCCHN. In Oct 2007, aprepitant was approved for use in Canada and immediately entered clinical use. We examined treatment delivery and health resource use in pts with LA SCCHN, before and after the introduction of aprepitant. Methods: LA SCCHN pts receiving HD cisplatin (>=70mg/m2) with curative intent Jan 2006-Jan 2009 were identified and data extracted including use of aprepitant, >=grade 2 N&V, hospitalization, chemotherapy delivery, and mortality. Outcomes in pts were compared pre- and post-Oct 2007. Results: HD cisplatin was administered 453 times (212 pre-/241 post-) in 179 pts (89 pre-/90 post-). Pts were similar pre- and post- with exception of more stage 4B disease treated post- (9 vs. 22%, p=0.02). HD cisplatin + RT was used in 202 treatments (95%) pre- vs. 186 (77%) post-; neoadjuvant docetaxel/cisplatin/5-FU (TPF) was used in 9 (4%) pre- vs. 55 (23%) post- (p<0.001). Aprepitant was used in 0% pre- and 82% post-. Rates of nausea and vomiting diminished (35 vs. 22%, 15 vs. 5%; p<0.001), more pts completed 2 and 3 cycles of HD cisplatin (85 vs. 96%, 53 vs. 72%; p<0.05) and 1 year mortality improved (21 vs. 8%, p=0.01) post-Oct 2007. Overall hospitalization and length of stay increased (43 vs. 52%, 5.9 vs. 7.3 days) due to admissions for administration and complications of neoadjuvant TPF. Conclusions: Most LA SCCHN pts treated with HD cisplatin received aprepitant once it was available. After the introduction of aprepitant, a greater proportion of pts were free of nausea or vomiting and completed planned chemotherapy. Despite increased use of multi-agent neoadjuvant chemotherapy and a higher proportion of pts with stage IVB disease treated, more pts were alive at 1 year in the post-aprepitant era. Although these retrospective data cannot prove causality, they suggest beneficial effects of aprepitant that allow improved treatment delivery by reducing treatment toxicity. No significant financial relationships to disclose.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".