Repurposed medicine shows unexpected promise in aggressive breast cancer

A commonly prescribed medicine used during cancer therapy has been linked to improved prognosis for women with early-stage breast cancer, with particularly strong benefits seen in those diagnosed with triple negative breast cancer.

Researchers from Monash University and the Norwegian Institute of Public Health analysed data from the Cancer Registry of Norway, including 13,811 women diagnosed between 2008 and 2020 who received chemotherapy along with anti-nausea medication aprepitant – a selective NK-1 receptor antagonist distributed locally by Southern Cross Pharma and Apotex – to manage treatment-related nausea and vomiting.

Their findings revealed that the use of aprepitant during chemotherapy was associated with an 11% reduction in the risk of cancer recurrence and a 17% lower risk of breast cancer–related death over a 10-year follow-up period. In contrast, other classes of anti-nausea drugs showed no significant connection with cancer outcomes.

Notably, the survival benefit of aprepitant was even more pronounced in women with triple negative breast cancer. In this group, aprepitant use corresponded to a 34% reduction in recurrence risk and a 39% decrease in mortality.

Dr Aeson Chang, senior author and researcher at the Monash Institute of Pharmaceutical Sciences, said “Because of the nature of triple negative breast cancer, there are fewer targeted treatment options, and therefore repurposing of drugs with well established safety profiles is an attractive path for rapid translation to improve cancer treatment and outcomes.

“Very little is known about how and why aprepitant use could impact long term survival outcomes in women with breast cancer, which is why we wanted to examine whether its use at the time of chemotherapy treatment may be linked with survival outcomes in a large population-based cohort of women with early-stage breast cancer.” 

Co-senior author Professor Erica Sloan added, “Triple negative breast cancer can be especially challenging to treat and with around 3,000 new cases diagnosed each year in Australia, new treatment pathways are important. We believe further studies are urgently needed to evaluate the effect of aprepitant in preventing cancer relapse and potentially inform new anti-nausea prescribing guidelines down the track.”

Chemotherapy-induced nausea and vomiting affect up to 60% of patients with early-stage breast cancer. Current guidelines recommend aprepitant primarily for chemotherapy regimens with a high risk of nausea and vomiting, but this study suggests there may be merit in considering broader use during treatment.

Dr Chang noted, “Generally speaking, when aprepitant is taken it’s during the first three days of chemotherapy treatment. Given the association between aprepitant and improved cancer outcomes uncovered in this study, it has led us to wonder if even greater survival would be observed if longer term use of aprepitant was factored into the patients dosing schedule.”

Dr Edoardo Botteri, the study’s first author and pharmacoepidemiologist at the Norwegian Institute of Public Health, highlighted the significance of the large patient cohort.

“Given what this study has uncovered, it’s essential these links are further explored – we now need to better understand why these associations have presented themselves and from there we can look at what this might mean for prescribing and dosing regimens in the future,” Dr Botteri said.

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