Акинзео® (нетупитант/палоносетрон) как основа современной профилактики тошноты и рвоты, индуцированной химиотерапией

   В настоящее время тошнота и рвота при химиотерапии остаются частыми побочными явлениями, которые влияют на качество и продолжительность жизни пациентов. Внедрение в клиническую практику нескольких классов антиэметиков и правильное применение различных препаратов в виде комбинированной схемы профилактики тошноты и рвоты позволяют эффективно контролировать данные побочные явления. Тем не менее в клинической практике частота тошноты и рвоты остается высокой, а по данным опросов, врачи недооценивают частоту развития данных осложнений у пациентов. Это в первую очередь объясняется некомплаентностью пациентов при использовании антиэметиков для профилактики отсроченной тошноты и рвоты по причине сложности соблюдения нужной кратности и доз при применении антиэметиков. Комбинированный пероральный препарат нетупитант + палоносетрон (Акинзео®) представляется оптимальным решением при данном нежелательном явлении. Однократный прием Акинзео® внутрь перед курсом химиотерапии позволяет не применять антагонисты 5-HT3-рецепторов и NK1-рецепторов для профилактики отсроченной тошноты и рвоты, что повышает комплаентность пациентов при приеме антиэметиков за счет упрощения режима терапии, снижает частоту развития тошноты и рвоты и улучшает качество жизни больных.

1. Navari R.M., Aapro M. Antiemetic prophylaxis for chemotherapyinduced nausea and vomiting. N Engl J Med 2016;374(14):1356–67. DOI: 10.1056/NEJMra1515442

2. Ballatori E., Roila F., Ruggeri B. et al. The impact of chemotherapyinduced nausea and vomiting on health-related quality of life. Support Care Cancer 2007;15(2):179–85. DOI: 10.1007/s00520-006-0109-7

3. Bloechl-Daum B., Deuson R.R., Mavros P. et al. Delayed nausea and vomiting continue to reduce patients’ quality of life after highly and moderately emetogenic chemotherapy despite antiemetic treatment. J Clin Oncol 2006;24(27):4472–8. DOI: 10.1200/JCO.2006.05.6382

4. Cohen L., de Moor C.A., Eisenberg P. et al. Chemotherapy-induced nausea and vomiting: incidence and impact on patient quality of life at community oncology settings. Support Care Cancer 2007;15(5):497–503. DOI: 10.1007/s00520-006-0173-z

5. Glaus A., Knipping C., Morant R. et al. Chemotherapy-induced nausea and vomiting in routine practice: a European perspective. Support Care Cancer 2004;12(10):708–15.

6. Basch E., Deal A.M., Dueck A.C. et al. Overall survival results of a trial assessing patient-reported outcomes for symptom monitoring during routine cancer treatment. JAMA 2017;318(2):197–8. DOI: 10.1001/jama.2017.7156

7. Bošnjak S.M., Gralla R.J., Schwartzberg L. Prevention of chemotherapyinduced nausea: the role of neurokinin-1 (NK1) receptor antagonists. Support Care Cancer 2017;25(5):1661–71. DOI: 10.1007/s00520-017-3585-z

8. Hesketh P.J., Kris M.G., Grunberg S.M. et al. Proposal for classifying the acute emetogenicity of cancer chemotherapy. J Clin Oncol 1997;15(1):103–9. DOI: 10.1200/JCO.1997.15.1.103

9. Grunberg S.M., Warr D., Gralla R.J. et al. Evaluation of new antiemetic agents and definition of antineoplastic agent emetogenicity – state of the art. Support Care Cancer 2011;19(Suppl 1):S43–S7. DOI: 10.1007/s00520-010-1003-x

10. Jordan K., Chan A., Gralla R.J. et al. 2016 updated MASCC/ESMO consensus recommendations: emetic risk classification and evaluation of the emetogenicity of antineoplastic agents. Support Care Cancer 2017;25(1):271–5. DOI: 10.1007/s00520-016-3332-x

11. [German Cancer Society. Guideline program oncology. Supportive therapy for oncological patients (In German)]. 2019. URL: https://www.leitlinienprogramm-onkologie.de/fileadmin/user_upload/Downloads/Leitlinien/Kolorektales_Karzinom/Version_2/GGPO_Guideline_Colorectal_Cancer_2.1.pdf

12. National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®). Antiemesis. Version 1.2020. Available at: https://sukhin-oncology.com.ua/wp-content/uploads/2023/06/Breast-cancer.pdf.

13. Aapro M., Ruffo P., Panteri R. et al. Oncologist perspectives on chemotherapy-induced nausea and vomiting (CINV) management and outcomes: a quantitative market research-based survey. Cancer Rep (Hoboken) 2018;1(4):e1127. DOI: 10.1002/cnr2.1127

14. Aapro M.S., Scotte F., Escobar Y. et al. Evaluation of practice patterns for prevention of chemotherapy (CT)-induced nausea and vomiting (CINV) and antiemetic guidelines (GLs) adherence based on real-world prescribing data. Ann Oncol 2018;29(Suppl 8):viii603. Abstract 1681O. DOI: 10.1093/annonc/mdy300

15. Dranitsaris G., Molassiotis A., Clemons M. et al. The development of a prediction tool to identify cancer patients at high risk for chemotherapy-induced nausea and vomiting. Ann Oncol 2017;28(6):1260–7. DOI: 10.1093/annonc/mdx100

16. Clark-Snow R.A., Affronti M.L., Rittenberg C.N. Chemotherapy-induced nausea and vomiting (CINV) and adherence to antiemetic guidelines: results of a survey of oncology nurses. Support Care Cancer 2018;26(2):557–64. DOI: 10.1007/s00520-017-3866-6

17. Dielenseger P., Börjeson S., Vidall C. et al. Evaluation of antiemetic practices for prevention of chemotherapy-induced nausea and vomiting (CINV): results of a European oncology nurse survey. Support Care Cancer 2019;27(11):4099–106. DOI: 10.1007/s00520-019-04697-1

18. Vidall C., Fernández-Ortega P., Cortinovis D. et al. Impact and management of chemotherapy/radiotherapy-induced nausea and vomiting and the perceptual gap between oncologists/oncology nurses and patients: a cross-sectional multinational survey. Support Care Cancer 2015;23(11):3297–305. DOI: 10.1007/s00520-015-2750-5

19. Rojas C., Slusher B.S. Pharmacological mechanisms of 5-HT3 and tachykinin NK1 receptor antagonism to prevent chemotherapyinduced nausea and vomiting. Eur J Pharmacol 2012;684(1–3):1–7. DOI: 10.1016/j.ejphar.2012.01.046

20. Hesketh P.J., Rossi G., Rizzi G. et al. Efficacy and safety of NEPA, an oral combination of netupitant and palonosetron, for prevention of chemotherapy-induced nausea and vomiting following highly emetogenic chemotherapy: a randomized dose-ranging pivotal study. Ann Oncol 2014;25(7):1340–6. DOI: 10.1093/annonc/mdu110

21. Aapro M., Rugo H., Rossi G. et al. A randomized phase III study evaluating the efficacy and safety of NEPA, a fixed-dose combination of netupitant and palonosetron, for prevention of chemotherapyinduced nausea and vomiting following moderately emetogenic chemotherapy. Ann Oncol 2014;25(7):1328–33. DOI: 10.1093/annonc/mdu101

22. Gralla R.J., Bosnjak S.M., Hontsa A. et al. A phase III study evaluating the safety and efficacy of NEPA, a fixed-dose combination of netupitant and palonosetron, for prevention of chemotherapyinduced nausea and vomiting over repeated cycles of chemotherapy. Ann Oncol 2014;25(7):1333–9. DOI: 10.1093/annonc/mdu096

23. Zhang L., Lu S., Feng J. et al. A randomized phase III study evaluating the efficacy of single-dose NEPA, a fixed antiemetic combination of netupitant and palonosetron, versus an aprepitant regimen for prevention of chemotherapy-induced nausea and vomiting (CINV) in patients receiving highly emetogenic chemotherapy (HEC). Ann Oncol 2018;29(2):452–8. DOI: 10.1093/annonc/mdx698

24. Schwartzberg L., Roeland E., Andric Z. et al. Phase III safety study of intravenous NEPA: a novel fixed antiemetic combination of fosnetupitant and palonosetron in patients receiving highly emetogenic chemotherapy. Ann Oncol 2018;29(7):1535–40. DOI: 10.1093/annonc/mdy169

25. Schwartzberg L., Navari R., Clark-Snow R. et al. Phase IIIb safety and efficacy of intravenous NEPA for prevention of chemotherapyinduced nausea and vomiting (CINV) in patients with breast cancer receiving initial and repeat cycles of anthracycline/cyclophosphamide (AC) chemotherapy. Oncologist 2020;25(3):e589–e97. DOI: 10.1634/theoncologist.2019-0527

26. Zelek L., Debourdeau P., Bourgeois H. et al. A pragmatic study evaluating NEPA versus aprepitant for prevention of chemotherapy-induced nausea and vomiting in patients receiving moderately emetogenic chemotherapy. Oncologist 2021;26(10):e1870–e9. DOI: 10.1002/onco.13888

27. Morrow G., Roscoe J.A., Hickok J.T. et al. Initial control of chemotherapy-induced nausea and vomiting in patient quality of life. Oncology (Williston Park) 1998;12(3 Suppl 4):32–7.