Although cough is a common and distressing symptom in lung cancer patients, there is almost no evidence to guide management. Aprepitant, a centrally acting neurokinin-1 inhibitor, significantly decreased cough frequency in a pilot study.
Patients with advanced lung cancer and cough lasting over two weeks despite a cough suppressant, were randomized 1:1 to aprepitant 125 mg orally on day one then 80 mg orally on days two to seven with physician’s choice of antitussive; or to physician’s choice of antitussive alone. Evaluation was at baseline and on days three, seven, nine and twelve. Primary endpoint was subjective cough improvement on day nine, measured by the Visual Analog Scale (VAS) and Manchester Cough in Lung Cancer Scale (MCLCS). Secondary endpoints included quality of life (QoL) as measured by the EORTC QLQ-C30 and QLQ-LC13 and toxicity.
Between 2017 and 2018, 128 patients were randomized. Median baseline cough duration was 90 days. Mean VAS scores (in mm) at baseline and day nine were 68 and 39 in the aprepitant arm and 62 and 49 in the control arm respectively, P<0.001; Mean MCLCS scores at baseline and day nine were 33 and 23 in aprepitant arm and 30 and 25 in control arm, P<0.001. Overall QoL was not significantly different between the two arms, however aprepitant led to a significant improvement in the cough-specific QoL domain, P=0.017. Aprepitant did not increase severe adverse events.
Aprepitant led to a significant improvement in cough in advanced lung cancer, without increasing severe side-effects.