Aprepitant for Cough Suppression in Advanced Lung Cancer: A Randomized Trial

Vanita Maria Noronha, Atanu Bhattacharjee, Vijay M. Patil, Amit Prakashchandra Joshi, Nandini Menon, Srushti Shah, Sadhana Kannan, Sadaf A. Mukadam, Kamesh Maske, Sandeep Ishi, Kumar Prabhash (Lead / Corresponding author)

Research output: Contribution to journalArticlepeer-review

15 Citations (Scopus)

Abstract

Background
Although cough is a common and distressing symptom in patients with lung cancer, there is almost no evidence to guide treatment. Aprepitant, a centrally acting neurokinin-1 inhibitor, significantly decreased cough frequency in a pilot study.
Methods
Patients with advanced lung cancer and cough lasting over 2 weeks despite a cough suppressant were randomized 1:1 to aprepitant 125 mg orally on day 1 and then 80 mg orally on days 2 to 7 with physician's choice of antitussive; or to physician's choice of antitussive alone. Evaluation was at baseline and on days 3, 7, 9, and 12. The primary end point was subjective cough improvement on day 9, measured by the Visual Analog Scale and Manchester Cough in Lung Cancer Scale. Secondary end points included quality of life (QoL) as measured by the European Organization for Research and Treatment of Cancer (EORTC) Core Quality of Life Questionnaire and the EORTC Lung Cancer-Specific Quality of Life Questionnaire and toxicity.
Results
Between 2017 and 2018, 128 patients were randomized. Median baseline cough duration was 90 days. Mean Visual Analog Scale scores (in mm) at baseline and day 9 were 68 and 39 in the aprepitant arm and 62 and 49 in the control arm, respectively (P < .001); mean Manchester Cough in Lung Cancer Scale scores at baseline and day 9 were 33 and 23 in the aprepitant arm and 30 and 25 in the control arm, respectively (P < .001). Overall QoL was not significantly different between the two arms; however, aprepitant led to a significant improvement in the cough-specific QoL domain (P = .017). Aprepitant did not increase severe adverse events.
Conclusions
Aprepitant led to a significant improvement in cough in advanced lung cancer, without increasing severe side effects.
Original languageEnglish
Pages (from-to)1647-1655
Number of pages9
JournalChest
Volume157
Issue number6
Early online date1 Mar 2020
DOIs
Publication statusPublished - Jun 2020

Keywords

  • antitussive
  • cough
  • Manchester Cough in Lung Cancer Scale
  • neurokinin
  • non-small cell lung cancer
  • repurposing

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