Netupitant/palonosetron (NEPA) for prophylaxis of nausea and vomiting induced by chemotherapeutic conditioning before autologous stem cell transplantation

Background. Combination of 5-HT3-receptor inhibitors and NK1-inhibitors with dexamethasone and olanzapine is the standard-of-care measure for prevention of chemotherapy-induced nausea and vomiting in autologous hematopoietic stem cell transplant (auto-HCT) recipients.

Aim. To assess the efficacy and toxicity of netupitant/palonosetron (NEPA) as monotherapy in the prevention of nausea and vomiting induced by pretransplant conditioning.

Materials and methods. This prospective study included patients (n = 21) who underwent auto-HCT at the P.A. Herzen Moscow Oncology Research Institute – branch of the National Medical Research Radiological Centre. Patients with multiple myeloma were administered 1 capsule of NEPA 1 hour before conditioning, patients with lymphoma – 2 capsules: 1 hour before conditioning and 72 hours after the first dose of the drug. The primary endpoint was the complete response rate defined as no emesis and no rescue medication during the acute and delayed phases.

Results. Complete response in the overall cohort was achieved in 81 % of patients both in the acute and delayed phases. In the high-dose melphalan group and LEAM-conditioning group (lomustine, etoposide, cytarabine, melphalan), the rates were also identical in the acute and delayed phases and were 75 and 88.9 %, respectively. Complete control in the entire cohort was achieved in 66.7 % during acute phase and 76.2 % during delayed phase. Corresponding rates in high-dose melphalan group were 66.7 and 75 %, respectively, and in LEAM-conditioning group – 66.7 and 77.8 %, respectively.

Conclusion. NEPA monotherapy demonstrates high efficacy in auto-HCT recipients receiving highly-emetogenic pretransplant conditioning, while simplifying the antiemetic prophylaxis protocol as compared to four-drug-based regimens.

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