Study Casts Doubt on Antiemetic Value of Ginger Supplement in Cisplatin Chemotherapy

Adding ginger extract capsules to a standard prophylactic antiemetic did not improve chemotherapy-induced nausea and vomiting (CINV) in patients undergoing high-dose cisplatin chemotherapy, according to a study published in the Annals of Oncology. However, subgroup analyses suggested possible, modest benefits to women and patients with head and neck cancers.

“In patients treated with high-dose cisplatin, the daily addition of ginger, even if safe, did not result in a protective effect on CINV,” reported lead study author Paolo Bossi, MD, of the Medical Oncology Unit at the Fondazione IRCCS National Cancer Institute in Milan, Italy, and coauthors.

CINV is a common and frequently-debilitating problem for patients undergoing chemotherapy. High-dose cisplatin therapy, like several other chemotherapy agents, is particularly emetogenic, inducing CINV in more than 90% of patients who do not receive a prophylactic antiemetic, the researchers noted.

Anecdotal reports and very small previous studies have suggested that ginger (Zingiber officinalis) might moderate nausea and gastrointestinal distress in CINV. Prior research suffered from “design inadequacies, heterogeneity of the population, poor quality of tested products, and the nonstandardized preparations of ginger,” the study authors noted.

The study team conducted a double-blind, placebo-controlled study to assess ginger’s effects on CINV. A total of 244 adults with cancer were randomly assigned to receive ginger (160 mg/d; n = 121) or placebo (n = 123). All patients also received a standard antiemetic prophylaxis for CINV: a NK-1 receptor antagonist and a 5-HT3 receptor antagonist on day 1 and dexamethasone on days 1–4.

Nearly half of patients in the study (49%) had lung cancer and 35% had head and neck cancer. Thirty-one percent of study participants were female and 61% had metastatic disease. The two study arms were well-balanced in terms of compliance and safety outcomes.

All patients were receiving high-dose cisplatin-based chemotherapy regimens. Patients completed daily visual-analogue scales and Functional Living Index Emesis questionnaires.

Overall, ginger had no effect on CINV. Subgroup analyses examining effects by gender and primary disease site revealed “poorer control of nausea with ginger in men and lung cancer patients,” the authors noted. Men receiving ginger experienced a higher incidence of delayed nausea (odds ratio [OR], 2.77; 95% CI, 1.16–6.64) and intercycle nausea (OR, 4.27; 95% CI, 1.6–11.37).

“The incidence of delayed, intercycle and anticipatory nausea did not differ between the two arms in the first cycle and the second cycle,” they reported. “A benefit of ginger over placebo in Functional Living Index Emesis nausea score differences”-the difference of day 6 vs day 1 scores-“was identified for females (P = .048) and head and neck cancer patients (P = .038).”

The possible beneficial effect of reduced nausea in women and patients with head and neck cancer warrants additional study, the authors concluded.