of action target different
neurotransmitter pathways
involved in nausea and vomiting,
combination therapy with a NK1
RA and 5-HT3 RA represents a
rational therapeutic strategy. 31,32
For example, NEPA (an oral
fixed combination of netupitant
300mg and palonosetron
0.5mg) given on day one of each
chemotherapy cycle together with
dexamethasone, was effective and
well tolerated in the prevention
of CINV in patients with solid
tumours undergoing MEC or HEC.
The authors commented that
NEPA offers convenience and, as a
simple guideline-based regimen,
has the potential to improve
adherence to guidelines, improving
the CINV control for patients. 32–36
A significantly higher percentage
(76.9%) of patients treated with
NEPA plus a single dose of
dexamethasone achieved CR (no
emesis, no rescue medication)
than those treated with oral
palonosetron (69.5%; p=0.001) in
the delayed (25–120 hours) phase
following AC and in the acute
(0–24 hours) phase (88.4% versus
85%; p=0.047) as well as overall
(0–120 hours) (74.3% versus 66.6%;
p=0.001). 34
In a FLIE assessment performed
by Aapro et al in 2014, a greater
proportion of NEPA-treated
patients reported NIDL for the
nausea, vomiting and combined
domains compared with oral
palonosteron. 34
In a study by Hesketh et al in
694 chemotherapy-naïve patients
undergoing cisplatin-based
chemotherapy for solid tumours,
three different oral doses of NEPA
(netupitant 100, 200 and 300mg
and 0.5mg palonosetron) provided
superior prevention of CINV
compared with oral palonosetron
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