Preventive effect of Rikkunshito, a traditional Japanese medicine, on chemotherapy-induced nausea and vomiting with cisplatin: Case series

Aim: Supportive therapies are important to treat chemotherapy-induced nausea and vomiting (CINV). Rikkunshito, a Kampo medicine, has been reported to be effective against cisplatin-induced anorexia in rats. In the present study, we evaluated the preventive effect of Rikkunshito for CINV in patients receiving high-dose cisplatin chemotherapy. Methods: We selected patients who received chemotherapy including cisplatin (≥60 mg/m²) for gastric or esophageal cancer between April 2010 and August 2012. We identified 20 patients treated without a reduction in the dose of anticancer medications during the second course and added 7.5 g/day Rikkunshito, which was orally administered, for 7 days. All patients were treated with 5-hydroxytryptamine-3 receptor antagonist, corticosteroid, and neurokinin-1 receptor antagonist for the prevention of CINV during the first and second courses. We evaluated complete response (CR; defined as no emesis and no rescue medication) and other toxicities according to the Common Terminology Criteria for Adverse Events version 4.0. Results: The median patient age was 63 years (range, 49–77 years). The chemotherapy regimens used were cisplatin plus 5-fluorouracil in 15 patients with esophageal cancer and cisplatin plus S-1 in five patients with gastric cancer. Rate of delayed CR was 75.0% during the first course (95% CI: 56.0–94.0%), which improved during the second course to 95.0% (95% CI: 85.4–100%, P = 0.077). There was no significant difference in other major toxicities between the first and second courses. Conclusion: Rikkunshito has the potential to alleviate CINV in patients receiving high-dose cisplatin chemotherapy.