How effective is a modified anti-nausea and vomiting treatment for patients with non-Hodgkin lymphoma undergoing chemotherapy?

This study examined the effectiveness of a modified anti-nausea and vomiting treatment for patients with aggressive non-Hodgkin lymphoma (NHL) receiving high-dose (HD) chemotherapy. The results showed that netupitant/palonosetron (NEPA; Akynzeo) alone was very effective and safe for these patients.

Chemotherapy often causes nausea and vomiting in patients with NHL. This seriously reduces patients’ quality of life and can affect their ability to complete treatment. Netupitant/palonosetron (NEPA) and dexamethasone (Decadron) are often prescribed to prevent or reduce the severity of nausea and vomiting. However, dexamethasone suppresses the immune system and this increases the risk of infections in patients. This especially affects patients who need stem cell transplants. It is unknown if NEPA without dexamethasone is effective for patients with NHL receiving chemotherapy.

70 patients with aggressive NHL that relapsed or did not respond to treatment receiving HD chemotherapy were given NEPA. Patients scored their nausea and vomiting symptoms on the days they received treatment and up to 48 hours after.

Overall, 87.1% of patients did not need extra anti-nausea and vomiting medication after receiving chemotherapy. On the days that patients received chemotherapy, 88.6% did not need extra medication. On the days following chemotherapy, 98.6% of patients did not need extra medication.

Complete control was defined as patients not requiring extra anti-nausea and vomiting medication and experiencing mild nausea or none at all. 85.7% of patients were reported to have complete control of nausea and vomiting symptoms. On the days that patients received chemotherapy, 88.6% had complete control of symptoms. On the days following chemotherapy, 95.7% of patients had complete control of symptoms.

88.6% of patients did not have any nausea or vomiting symptoms. 90% of patients did not have any symptoms during the days they received chemotherapy. 98.6% of patients did not have any symptoms on the days following chemotherapy.

Less than 10% of patients experienced moderate or severe nausea during the course of chemotherapy. Every day of the trial, more than 65% of patients had no nausea. Patients reported a satisfaction score of 9.13 out of 10 for the treatment of nausea and vomiting symptoms with NEPA.

8.6% of patients developed side effects from NEPA treatment. Side effects included constipation and fever.

The authors concluded that NEPA without dexamethasone effectively prevented nausea and vomiting in patients with NHL receiving high-dose chemotherapy.

This study did not compare NEPA results to a comparison such as NEPA and dexamethasone. There were a small number of patients in this study so results should be confirmed on a larger sample.