Pre-Treatment Anti-Nausea Medication May Improve Liver Cancer Treatment

Administering an anti-nausea and vomit medication prior to drug eluting bead chemoembolization (DEB TACE) treatments in liver cancer patients could help reduce hospital stay lengths, as well as lowering the risk of complication-related readmission.

DEB TACE delivers chemotherapy locally to the tumor through drug coated beads, restricting the tumor’s blood supply. However, this therapy can result in common side effects such as postembolization syndrome (PES), which can cause pain, nausea, vomiting, and fevers.

“It usually occurs within the first 72 hours after the procedure and then starts to subside after 72 hours,” said principal study investigator Abouelmagd Makramalla, MD. “Standard practice is to hospitalize these patients for 1 to 2 days for observation; however, we wanted to see if adding fosaprepitant to the medication regimen, which prevents nausea and vomiting, prior to DEB TACE treatment would allow for the procedure to be outpatient and prevent hospital readmission for PES.”

Researchers used a database that contained patients from the University of Cincinnati College of Medicine to examine liver cancer patients who had undergone DEB TACE over a 23-month period. The findings were presented at the World Conference on Interventional Oncology.

A small sample size consisting of 113 consecutive procedures in 71 patients were used. Patients were given premedication with dexamethasone, a steroid, and fosaprepitant.

After the procedure, patients were given anti-nausea medication, as well as painkillers, as needed. Discharge medications included painkillers, an antibiotic, and anti-nausea drugs.

“Of the 113 DEB TACE procedures, only 5 patients (4.4%), were admitted for PES,” Makramalla said.

Makramalla noted that 108 treatments (96.4%) were found to be successful, and did not develop post-procedural PES that required hospitalization.

“These findings suggest that outpatient DEB TACE could be possible with premedication and a low incidence of hospital readmission for PES; this could allow the patient to recover more comfortably in their home and save both the patient and the hospital time and money,” Makramalla said. “We need larger studies to determine if this could become a standard pre-treatment regimen.”