Preventing nausea and vomiting during chemotherapy

This review was conducted in an effort to update current guidelines for the prevention of nausea and vomiting in patients receiving chemotherapy.

According to this update by the American Society of Clinical Oncology, all patients who receive highly emetogenic chemotherapies (treatments known to cause nausea and vomiting) should be offered a three-drug combination of an NK1-receptor antagonist, a 5-HT3 receptor antagonist, and dexamethasone.

NEPA combination (Akynzeo) plus dexamethasone is a safe and effective treatment option in this setting.

Chemotherapy is an effective treatment option for many types of cancer, including colorectal cancer. Chemotherapy-induced side-effects, such as nausea and vomiting, are common and may have a dramatic effect on the well-being and quality of life of patients. Common drugs used to treat nausea and vomiting during chemotherapy (also called anti-emetic drugs) include steroids such as dexamethasone, 5-HT3 receptor antagonists such as ondansetron (Zofran) or palonosetron, and NK1-receptor antagonists such as aprepitant (Emend) or netupitant.

NEPA oral combination therapy (a pill containing a combination of netupitant and palonosetron) is currently being investigated as a standardized treatment for the prevention of nausea and vomiting during chemotherapy. This review analyzed three recent clinical trials investigating NEPA combination therapy in an effort to update the American Society of Clinical Oncology anti-emetic guidelines.

A recent study compared NEPA combination therapy with palonosetron treatment in 1,449 patients undergoing their first cycle of chemotherapy. All patients also received dexamethasone. Overall, NEPA combination therapy was more effective in preventing vomiting and nausea than palonosetron. 74% of patients treated with NEPA combination therapy reported complete response (no vomiting or need for additional anti-nausea medication) after chemotherapy, compared with 67% of patients receiving palonosetron.

Similar findings were reported in a study comparing different doses of NEPA combination therapy with palonosetron in 694 patients undergoing chemotherapy (all patients also received dexamethasone). NEPA combination therapy was found to be superior to palonosetron in preventing vomiting and nausea, regardless of dose administered. However, the highest dose of NEPA was associated with the highest effectiveness. Treatment with aprepitant plus ondansetron was noted to be equally effective to NEPA combination therapy.

Another study compared the effectiveness of NEPA combination therapy with that of palonosetron plus aprepitant combination in 413 patients undergoing chemotherapy (following initial treatment with dexamethasone). A complete response was noted in 81% of patients treated with NEPA combination therapy and in 76% of patients receiving palonosetron plus aprepitant. Importantly, the prevention of vomiting and nausea symptoms was maintained for up to six cycles of high-dose chemotherapy.

Headache and constipation were the most common side-effects associated with NEPA combination therapy. However, the overall rate of side effects was low (reported in less than 4% of patients) and similar among the different treatment groups.

The authors conclude that NEPA combination therapy, together with dexamethasone, is safe and effective in preventing chemotherapy-induced nausea and vomiting.