How effective is a netupitant and palonosetron combination in preventing nausea and vomiting in patients with multiple myeloma?

This study assessed the effectiveness of netupitant/palonosetron (NEPA; Akynzeo) in preventing nausea and vomiting in patients with multiple myeloma (MM) while receiving high-dose melphalan (HDM; Alkeran) and autologous stem cell transplantation (ASCT). The data showed that NEPA, without dexamethasone (DXM; Decadron), was well-tolerated and effective in preventing nausea and vomiting in patients with MM that received HDM, then ASCT.

High-dose chemotherapy and ASCT are used in the treatment of patients with MM. HDM (200 mg/m²) is the chemotherapy commonly given to patients with MM, before receiving ASCT. Two major drawbacks associated with chemotherapy are nausea and vomiting.

Palonosetron (PALO; Aloxi) is used combined with DXM to prevent nausea and vomiting in patients with MM. However, it has been reported to be associated with delayed vomiting. NEPA is an oral combination of 2 medications that prevent nausea and vomiting that have shown good response in patients receiving chemotherapy. However, the effect of administering NEPA for the prevention of nausea and vomiting in patients with MM receiving HDM before ASCT remains unclear.

This study included 106 patients with MM undergoing HDM and ASCT. Patients received NEPA 1 hour before chemotherapy conditioning, then after 72 hours and 120 hours. Patients were monitored for nausea and vomiting. A complete response (CR) was based on no vomiting and no rescue medication. CR was assessed during the acute phase (0 to 24 hours), the delayed phase (25 to 120 hours) from the start of HDM. Patients were followed every day until day 10 after ASCT.

At 120 hours, 93% of patients had a CR. There was a 94% CR rate for the acute phase and a 95% CR rate for the delayed phase.

82% of patients had mild nausea, while 12% of patients had mild vomiting. 

The study showed that NEPA was effective in controlling nausea and vomiting in patients with MM that received HDM followed by ASCT.

All patients received the treatment. There was no control group. Further studies are needed.