The place of netupitant and palonosetron combination in prevention of chemotherapy-associated nausea and vomiting

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Abstract

Chemotherapy-associated nausea and vomiting remain one of the most significant problems in oncology despite development of modern antiemetics. These symptoms decrease patients’ quality of life and treatment compliance and can lead to clinically significant complications including dehydration, electrolyte imbalances, and modification of antitumor therapy.

Pathogenesis of chemotherapy-associated nausea and vomiting is multifactorial and includes activation of both peripheral and central mechanisms, with key being serotoninergic and neuroendocrine NK1 receptors. This underlies the necessity of using combination antiemetic therapy directed at various parts of vomiting reflex pathogenesis. Modern clinical guidelines make provisions for multicomponent schemes, but their efficacy is limited by low patient adherence and development of adverse effects.

Netupitant and palonosetron combination (NEPA) is a mixture of NK1 receptor antagonist and 5-HT3 receptor antagonist which affect the key mechanisms of chemotherapy-associated nausea and vomiting. Pharmacokinetic characteristics of the components allow to use the drug once prior to administration of chemotherapy in combination with dexamethasone which makes therapy more comfortable and increase patients’ compliance.

According to randomized clinical trials, NEPA demonstrates high efficacy in prevention of both acute and delayed chemotherapy-associated nausea and vomiting during moderately and highly emetogenic chemotherapies leading to high rates of complete remission and similar or more favorable safety profile compared to the standard of care. Additional benefits include lower need for salvage therapy and potentially lower treatment costs.

Therefore, the use of NEPA combination is a justified and effective approach to prevention of chemotherapy-associated nausea and vomiting and allows to optimize antiemetic therapy through increased efficacy, safety and treatment adherence.

About the authors

A. A. Ivanov

MAMMA Medical Clinic

Author for correspondence.
Email: dr_anton_ivanov@mail.ru
ORCID iD: 0000-0001-6091-0848
Russian Federation, 7B Vokzalnaya St., Odintsovo, 143007

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