Premedication with NK-1 antagonists and COX-2 inhibitors improves same day discharge rates following chemoembolization for hepatocellular carcinoma and neuroendocrine liver metastasis

Tuesday, April 1, 2025

4:21 PM – 4:30 PM CT

Location: Music City Center, 209 ABC

Presenting Author(s)

Karan Rao, MD

IR Resident
University of Pennsylvania, United States

Author/Co-author(s)

SK

Samar Kayfan, MD

Interventional Radiology Resident
University of Pennsylvania, United States
RR

Robert C. Romano, MD

resident
University of Pennsylvania, United States
Gregory J. Nadolski, MD

MD
Hospital of the University of PA, United States
Daniel M. DePietro, MD

Assistant Professor
University of Pennsylvania, United States
MD

Mandeep Dagli, MD

Associate Professor of Radiology
Hospital of the University of Pennsylvania, United States
SS

Susan Shamimi-Noori, MD

Program Director
University of Pennsylvania, United States
JM

Jeffrey Mondschein, MD

Associate Professor of Clinical Radiology
University of Pennsylvania, United States
Ryan M. Cobb, MD (he/him/his)

Assistant Professor
Hospital of the University of Pennsylvania, United States
SH

Stephen J. Hunt, MD, PhD, FSIR (he/him/his)

Associate Professor
University of Pennsylvania, United States
Michael C. Soulen, MD

Professor
Abramson Cancer Center, University of Pennsylvania, United States

Purpose: Postembolization syndrome is common following transarterial chemoembolization (TACE) and bland embolization (TAE) for hepatocellular carcinoma (HCC) and neuroendocrine (NET) liver metastasis. NCCN antiemesis guidelines include neurokinin-1 antagonists (NK-1) in patients receiving emetogenic chemotherapy {1}, however, these agents are not specified in current SIR guidelines {2}. Surgical RCT's demonstrate decreased narcotic requirements when preoperative COX-2 inhibitors are given {3}. The purpose of this study was to determine if adding an NK-1 antagonist and COX-2 inhibitor reduced post-procedural antiemetic and narcotic use, or improved same day discharge rates following TACE/TAE for HCC and NET liver metastasis.

Materials and Methods:

Retrospective review of consecutive patients undergoing TACE/TAE for HCC or NET liver metastasis from January 2023 – August 2024. Intravenous fosprepitant 150 mg IV and ketorolac 15-30 mg IV were introduced as premedication beginning February 2024. Data was collected on percentage dose delivered via TACE, amount of liver embolized, tumor burden in treated liver, and premedication utilization. Outcomes included any post-procedure use of anti-emetics and narcotics and same day discharge.

Results:

250 patients with HCC (153, 61%) or NET (97, 39%) underwent TACE (215, 86%) or TAE (35, 14%). Mean (SD) TACE dose was 70 ± 29 %. 119 ( 48%) underwent lobar embolization, and 131 (52%) underwent segmental embolization. All HCC patients and 76% of NET patients had a tumor burden < 25% in the treated liver.

52 patients received dual premedication. 5/250 (2%) patients were planned admissions and excluded from the same day discharge analysis. There was a statistically significant association between patients who received premedication, decreased post-procedural antimetic use, and same day discharge (Table 1).

Conclusion:

Premedication with an NK-1 antagonist and COX-2 inhibitor significantly improved same day discharge, and had variable association with postprocedural antiemetic and narcotic use.