A Study Comparing the Efficacy of Ondansetron, Palenosetron and Aprepitant in the Prevention of Chemotherapy induced Nausea and Vomiting in Breast Cancer patients receiving Moderately Emetogenic Chemotherapy.

Introduction: Nausea and vomiting are the most feared complications of chemotherapy experienced By the patients.1,2.Almost 70-80% of all cancer patients will be having chemotherapy induced Nausea and vomiting.3,4 The prevention of chemotherapy induced nausea and vomiting (CINV) is Very much important and necessary because it has huge implications on both patient’s and Clinician’s perspective. As it is the most common problem faced by patients and as it can be Prevented or controlled to a certain extent with the judicious and careful use of anti emetics sums Up the significance of the need to select an appropriate anti emetic regimen for a particular class Of chemotherapy. Prevention is always better than cure ,which is an old age saying holds very true in the Perspective of CINV also because it is always important to prevent CINV rather than treat CINV As damage would have already occurred in the form of poor oral intake, affection of quality of Life , anxiety in the minds of patients ,creating doubts about their ability to tolerate further Chemotherapy thus leading to anticipatory vomiting in the subsequent cycles or loss of Compliance leading to inadequate treatment of the disease and last but not the least the financial Burden on the individual and the family for supportive care, hospital admission and the rescue Medications .5 Treatment of breast cancer also has undergone considerable improvement in the recent Times leading to increased chance of cure .Hence it becomes extremely important to provide the Cure with least toxicities and side effects of treatment. The chemotherapy used in breast cancer Patients falls under moderately emetogenic chemotherapy type (MEC) 6 . The choice of anti Emetic regimen in patients treated for highly emetogenic chemotherapy is clear and non Controversial. The same cannot be told about the anti emetic regimen in patients receiving MEC.7The development of newer anti emetic agents like palonosetron, aprepitant, fosaprepitant And casopitant has led to tremendous opportunities and improved patient care. Conventionally Ondansetron was the anti emetic of choice for patients receiving MEC but now with the advent of Aprepitant it is becoming the new standard of care as an antiemetic regimen of choice in patients Receiving MEC especially those receiving a combination of anthracycline and an alkylating Agent.7 There are only a few trials and studies using aprepitant in patients receiving MEC and in Fact there are no studies till date comparing palonosetron with aprepitant in the prevention of CINV in MEC. Hence our study is a sincere effort in that regard trying to compare palonosetron And aprepitant to ondansetron. And we also have compared palonosetron with aprepitant with Respect to their efficacies in the prevention of CINV .This will be of great help to a limited Resource country like ours, where a cheaper alternative can be of great relief to the patient Herself/himself and also to the treating centres and also will have great financial implications If a Cheaper alternative is obtained. AIM: PRIMARY OUTCOME To compare the Complete response rates in the ondansetron, palonosetron and Aprepitant based antiemetic prophylaxis regimen in patients of breast cancer patients Receiving moderately emetogenic chemotherapy SECONDARY OUTCOMES To determine the complete response during the acute phase after initiation of Chemotherapy To determine the complete response during the delayed phase after initiation of Chemotherapy To determine the impact of CINV on quality of life using the Functional living Index- Emesis(FLIE) scores in each of the 3 arms To determine the effect of antiemetic agents on the reduction of usage of rescue Medication