Fixed combination of oral NEPA (netupitant-palonosetron) for the prevention of acute and delayed chemotherapy-induced nausea and vomiting in patients receiving multiple cycles of chemotherapy: Efficacy data from 2 randomized, double-blind phase III studies

Cancer Med. 2019 May;8(5):2064-2073. doi: 10.1002/cam4.2091. Epub 2019 Apr 9.

Abstract

Aim: To assess the efficacy of oral NEPA (netupitant-palonosetron 300/0.50 mg) over multiple chemotherapy cycles.

Methods: Two randomized phase III studies evaluated a single dose of oral NEPA given on day 1 in chemotherapy-naive patients receiving anthracycline-cyclophosphamide (AC)-based (Study 1) or highly (HEC)/moderately (MEC) emetogenic chemotherapy (safety Study 2). Oral NEPA was compared with oral palonosetron 0.50 mg (Study 1) or oral aprepitant 125 mg day 1, 80 mg days 2-3/palonosetron 0.50 mg (Study 2; no formal statistical comparisons). Oral dexamethasone was administered in all treatment groups. Complete response (CR; no emesis/no rescue medication), no emesis, and no significant nausea (NSN) rates during acute (0-24 h) and delayed (>24-120 h) phases of chemotherapy cycles 1-4 in each study were evaluated.

Results: In Study 1, 1450 patients received 5969 chemotherapy cycles; in Study 2, 412 patients received 1961 chemotherapy cycles. In each study, ≥75% of patients completed 4 or more cycles. In Study 1, oral NEPA was superior to palonosetron in preventing chemotherapy-induced nausea and vomiting (CINV) in the acute and delayed phases of cycle 1, with higher rates of CR (all P < 0.05), no emesis (all P < 0.05), and NSN (delayed phase P < 0.05 cycles 1, 2, and 4) reported across 4 cycles. In Study 2, oral NEPA had numerically higher CR and NSN rates in the acute and delayed phases than aprepitant-palonosetron in MEC/HEC patients.

Conclusion: Oral NEPA was highly effective in preventing both acute and delayed CINV over multiple chemotherapy cycles of HEC, AC, and MEC regimens.

Clinical trial registration numbers: Study 1, NCT01339260; Study 2, NCT01376297.

Keywords: CINV; NEPA; delayed phase; efficacy; multiple cycles; netupitant.

Publication types

  • Clinical Trial, Phase III
  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Administration, Oral
  • Anthracyclines / adverse effects
  • Antiemetics / administration & dosage*
  • Antiemetics / therapeutic use
  • Aprepitant / administration & dosage*
  • Aprepitant / therapeutic use
  • Cyclophosphamide / adverse effects
  • Dexamethasone / administration & dosage*
  • Dexamethasone / therapeutic use
  • Double-Blind Method
  • Drug Combinations
  • Drug-Related Side Effects and Adverse Reactions / prevention & control*
  • Female
  • Humans
  • Isoquinolines / administration & dosage*
  • Isoquinolines / therapeutic use
  • Male
  • Middle Aged
  • Palonosetron / administration & dosage*
  • Palonosetron / therapeutic use
  • Pyridines / administration & dosage*
  • Pyridines / therapeutic use
  • Quinuclidines / administration & dosage*
  • Quinuclidines / therapeutic use
  • Treatment Outcome

Substances

  • Anthracyclines
  • Antiemetics
  • Drug Combinations
  • Isoquinolines
  • Pyridines
  • Quinuclidines
  • netupitant, palosentron drug combination
  • Aprepitant
  • Palonosetron
  • Dexamethasone
  • Cyclophosphamide

Associated data

  • ClinicalTrials.gov/NCT01339260
  • ClinicalTrials.gov/NCT01376297