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Gupta S, Mv C, Thomas B, Biswas G, Gupta S, Dattatreya PS, Bhagat S, Patil S, Bhushan S, Barkate H. An Open-Label, Single-Arm, Multicenter, Observational Study Evaluating the Safety and Effectiveness of Akynzeo® in the Management of Chemotherapy-Induced Nausea and Vomiting in India. Cureus 2024; 16:e56447. [PMID: 38638750 PMCID: PMC11024873 DOI: 10.7759/cureus.56447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2024] [Indexed: 04/20/2024] Open
Abstract
Background Chemotherapy-induced nausea and vomiting is a common and unpleasant treatment-related side effect reported by cancer patients receiving chemotherapy. Akynzeo® or NEPA (NEtupitant + PAlonosetron) is the first fixed combination of netupitant and palonosetron that targets both critical pathways involved in emesis while providing a convenient, single oral dose therapy. The current study aimed to assess the effectiveness and safety of NEPA in a real-world setting in India. Methodology This was an open-label, multicenter, prospective, single-arm study conducted at six different locations across India. The study included patients of either gender, aged ≥18 years, naive to chemotherapy, scheduled to receive highly or moderately emetogenic chemotherapy (HEC/MEC), and scheduled to receive oral NEPA, as determined by the investigator. Results A total of 360 people were screened and enrolled in the study. HEC was prescribed to 289 (81.64%) patients, while MEC was prescribed to 65 (18.36%) patients. Complete response was achieved in 94.92% of patients during the acute phase, 95.20% during the delayed phase, and 93.22% during the overall phase. During the overall phase, 92.73% and 95.38% of patients on the HEC and MEC regimens, respectively, achieved complete response. Adverse events were reported in 3.88% of patients. Conclusions Oral NEPA was found to be effective in the Indian real-world setting, eliciting a >90% complete response with HEC and MEC regimens across the acute, delayed, and overall phases.
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Affiliation(s)
- Sudeep Gupta
- Medical Oncology, Tata Memorial Centre/Hospital & Homi Bhabha National Institute, Mumbai, IND
| | - Chandrakanth Mv
- Medical Oncology, Narayana Superspeciality Hospital, Kolkata, IND
| | - Boben Thomas
- Medical Oncology, Caritas Hospital, Kottayam, IND
| | - Ghanshyam Biswas
- Medical Oncology, Sparsh Hospital & Critical Care, Bhubaneswar, IND
| | - Sumant Gupta
- Medical Oncology, Sarvodaya Hospital & Research Centre, Faridabad, IND
| | | | - Sagar Bhagat
- Global Medical Affairs, Glenmark Pharmaceuticals Limited, Mumbai, IND
| | - Saiprasad Patil
- Global Medical Affairs, Glenmark Pharmaceuticals Limited, Mumbai, IND
| | - Sumit Bhushan
- Global Medical Affairs, Glenmark Pharmaceuticals Limited, Mumbai, IND
| | - Hanmant Barkate
- Global Medical Affairs, Glenmark Pharmaceuticals Limited, Mumbai, IND
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Herrstedt J, Clark-Snow R, Ruhlmann CH, Molassiotis A, Olver I, Rapoport BL, Aapro M, Dennis K, Hesketh PJ, Navari RM, Schwartzberg L, Affronti ML, Garcia-Del-Barrio MA, Chan A, Celio L, Chow R, Fleury M, Gralla RJ, Giusti R, Jahn F, Iihara H, Maranzano E, Radhakrishnan V, Saito M, Sayegh P, Bosnjak S, Zhang L, Lee J, Ostwal V, Smit T, Zilic A, Jordan K, Scotté F. 2023 MASCC and ESMO guideline update for the prevention of chemotherapy- and radiotherapy-induced nausea and vomiting. ESMO Open 2024; 9:102195. [PMID: 38458657 PMCID: PMC10937211 DOI: 10.1016/j.esmoop.2023.102195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 11/06/2023] [Indexed: 03/10/2024] Open
Abstract
•Nausea and vomiting are considered amongst the most troublesome adverse events for patients receiving antineoplastics. •The guideline covers emetic risk classification, prevention and management of treatment-induced nausea and vomiting. •The Consensus Committee consisted of 34 multidisciplinary, health care professionals and three patient advocates. •Recommendations are based on evidence-based data (level of evidence) and the authors’ collective expert opinion (grade). •All recommendations are for the first course of antineoplastic therapy; modifications may be needed in subsequent courses.
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Affiliation(s)
- J Herrstedt
- Department of Clinical Oncology, Zealand University Hospital Roskilde and Naestved, Roskilde; Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - R Clark-Snow
- Oncology Supportive Care Consultant, Overland Park, USA
| | - C H Ruhlmann
- Department of Oncology, Odense University Hospital, Odense; Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - A Molassiotis
- College of Arts, Humanities and Education, University of Derby, Derby, UK
| | - I Olver
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia
| | - B L Rapoport
- The Medical Oncology Centre of Rosebank, Johannesburg; Department of Immunology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - M Aapro
- Genolier Cancer Center, Genolier, Switzerland
| | - K Dennis
- Division of Radiation Oncology, The Ottawa Hospital and the University of Ottawa, Ottawa, Canada
| | - P J Hesketh
- Division of Hematology Oncology, Lahey Hospital and Medical Center, Burlington
| | | | - L Schwartzberg
- William N. Pennington Cancer Institute, University of Nevada, Reno School of Medicine, Reno
| | - M L Affronti
- Department of Neurosurgery, The Preston Robert Tisch Brain Tumor Center, Duke University Medical Center, Durham; Duke University School of Nursing, Duke University, Durham, USA
| | - M A Garcia-Del-Barrio
- Pharmacy Department, Clínica Universidad de Navarra, Madrid; School of Pharmacy and Nutrition, Universidad de Navarra, Pamplona, Spain
| | - A Chan
- Department of Clinical Pharmacy Practice, School of Pharmacy & Pharmaceutical Sciences, University of California Irvine, Irvine, USA
| | - L Celio
- Independent Medical Oncologist, Milan, Italy
| | - R Chow
- Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - M Fleury
- Department of Oncology, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - R J Gralla
- Albert Einstein College of Medicine, Jacobi Medical Center, Bronx, USA
| | - R Giusti
- Medical Oncology Unit, Sant' Andrea Hospital of Rome, Rome, Italy
| | - F Jahn
- Clinic for Internal Medicine IV, Oncology - Hematology - Hemostaseology, University Hospital Halle (Saale), Halle, Germany
| | - H Iihara
- Department of Pharmacy, Gifu University Hospital, Gifu, Japan
| | | | - V Radhakrishnan
- Department of Medical Oncology, Cancer Institute (WIA), Adyar, Chennai, India
| | - M Saito
- Department of Breast Oncology, Juntendo University School of Medicine, Tokyo, Japan
| | - P Sayegh
- Department of Pharmacy, OU Health Stephenson Cancer Center, Oklahoma City, USA
| | - S Bosnjak
- Department of Supportive Oncology and Palliative Care, Institute for Oncology and Radiology of Serbia, Belgrade, Serbia
| | - L Zhang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - J Lee
- College of Nursing and Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul, Korea
| | - V Ostwal
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - T Smit
- The Medical Oncology Centre of Rosebank, Johannesburg
| | - A Zilic
- Department of Supportive Oncology and Palliative Care, Institute for Oncology and Radiology of Serbia, Belgrade, Serbia
| | - K Jordan
- Department of Hematology, Oncology and Palliative Medicine, Ernst von Bergmann Hospital, Potsdam; Department of Medicine V, Hematology, Oncology and Rheumatology, University of Heidelberg, Heidelberg, Germany
| | - F Scotté
- ∗Interdisciplinary Patient Pathway Division, Gustave Roussy, Villejuif, France.
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3
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Herrstedt J, Celio L, Hesketh PJ, Zhang L, Navari R, Chan A, Saito M, Chow R, Aapro M. 2023 updated MASCC/ESMO consensus recommendations: prevention of nausea and vomiting following high-emetic-risk antineoplastic agents. Support Care Cancer 2023; 32:47. [PMID: 38127246 PMCID: PMC10739516 DOI: 10.1007/s00520-023-08221-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
PURPOSE This systematic review updates the MASCC/ESMO recommendations for high-emetic-risk chemotherapy (HEC) published in 2016-2017. HEC still includes cisplatin, carmustine, dacarbazine, mechlorethamine, streptozocin, and cyclophosphamide in doses of > 1500 mg/m2 and the combination of cyclophosphamide and an anthracycline (AC) in women with breast cancer. METHODS A systematic review report following the PRISMA guidelines of the literature from January 1, 2015, until February 1, 2023, was performed. PubMed (Ovid), Scopus (Google), and the Cochrane Database of Systematic Reviews were searched. The literature search was limited to randomized controlled trials, systematic reviews, and meta-analyses. RESULTS Forty-six new references were determined to be relevant. The main topics identified were (1) steroid-sparing regimens, (2) olanzapine-containing regimens, and (3) other issues such as comparisons of antiemetics of the same drug class, intravenous NK1 receptor antagonists, and potentially new antiemetics. Five updated recommendations are presented. CONCLUSION There is no need to prescribe steroids (dexamethasone) beyond day 1 after AC HEC, whereas a 4-day regimen is recommended in non-AC HEC. Olanzapine is now recommended as a fixed part of a four-drug prophylactic antiemetic regimen in both non-AC and AC HEC. No major differences between 5-HT3 receptor antagonists or between NK1 receptor antagonists were identified. No new antiemetic agents qualified for inclusion in the updated recommendations.
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Affiliation(s)
- Jørn Herrstedt
- Department of Clinical Oncology, Zealand University Hospital, Sygehusvej 10, DK-4000, Roskilde, Denmark.
- Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
| | | | - P J Hesketh
- Division of Hematology Oncology, Lahey Hospital and Medical Center, Burlington, MA, USA
| | - L Zhang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - R Navari
- World Health Organization, Birmingham, Alabama, USA
| | - A Chan
- Department of Clinical Pharmacy Practice, School of Pharmacy & Pharmaceutical Sciences, University of California Irvine, Irvine, CA, USA
| | - M Saito
- Department of Breast Oncology, Juntendo University School of Medicine, Tokyo, Japan
| | - R Chow
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - M Aapro
- Genolier Cancer Center, Genolier, Switzerland
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Abe M, Iihara H, Aogi K. Fosnetupitant for the Prevention of Chemotherapy-Induced Nausea and Vomiting: A Short Review and Clinical Perspective. Adv Ther 2023; 40:1913-1925. [PMID: 36884027 PMCID: PMC10129973 DOI: 10.1007/s12325-023-02474-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 02/17/2023] [Indexed: 03/09/2023]
Abstract
Chemotherapy-induced nausea and vomiting (CINV) is often ranked by patients as one of the most distressing and feared consequences of chemotherapy. The novel neurokinin-1 (NK1) receptor antagonist fosnetupitant, a phosphorylated prodrug formulation of netupitant, was approved in Japan in 2022. Fosnetupitant is one of the standard treatments for the prevention of CINV in patients who are receiving highly (any treatment where CINV occurs in more than 90% of patients) or moderately (where CINV occurs in 30-90% of patients) emetogenic chemotherapies. The aim of this commentary is to describe the mechanism of action, tolerability, and antiemetic efficacy of single-agent fosnetupitant in the prevention of CINV, and to discuss its clinical application, in order to aid optimal use.
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Affiliation(s)
- Masakazu Abe
- Department of Obstetrics and Gynecology, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-Ku, Hamamatsu, Shizuoka, 431-3192, Japan.
| | | | - Kenjiro Aogi
- Department of Breast Oncology, National Hospital Organization Shikoku Cancer Center, Matsuyama, Japan
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Filetti M, Lombardi P, Giusti R, Falcone R, Scotte F, Giannarelli D, Carcagnì A, Altamura V, Scambia G, Daniele G. Efficacy and safety of antiemetic regimens for highly emetogenic chemotherapy-induced nausea and vomiting: A systematic review and network meta-analysis. Cancer Treat Rev 2023; 115:102512. [PMID: 36774658 DOI: 10.1016/j.ctrv.2023.102512] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 01/16/2023] [Accepted: 01/18/2023] [Indexed: 01/22/2023]
Abstract
BACKGROUND Several regimens have been introduced in clinical practice in the last twenty years to treat chemotherapy-induced nausea and vomiting (CINV). However, direct comparative data remain insufficient, as many new regimes lack head-to-head comparisons. In this study, through an indirect comparison, we overcome this limit by providing the most up-to-date estimate of the efficacy and safety of all combinations used for HEC-induced nausea and vomiting. PATIENTS AND METHODS We retrieved randomized controlled trials (RCTs) published in Pubmed, Embase, and Cochrane Library until June, 30th 2022. We included phase II-III RCTs, including adults with any cancer receiving HEC, and compared different antiemetic regimes to prevent CINV. The primary outcome was the overall complete response (defined as the absence of vomiting and of the use of rescue drugs from 0 to 120 hrs since chemotherapy); secondary outcomes were acute (absence of vomiting and use of rescue medicine 0-24 hrs after chemotherapy) and delayed (24-120 hrs) response and adverse events. RESULTS A total of 53 RCTs enrolling 22 228 patients were included. We classified the different antiemetic regimes into 21 different groups. Overall, 3- or 4-drug regimens containing a combination of dexamethasone, 5HT3 antagonists, mirtazapine or olanzapine with or without NK antagonists, yielded the highest probability to be the most effective regimen in terms of complete response. Regimens containing a combination of dexamethasone and 5-HT3 antagonist have the lowest probability of being the most effective regimen in terms of complete, acute, and delayed response. CONCLUSION In our network meta-analysis, 4-drug regimens with olanzapine displayed the highest probability of efficacy in terms of complete response. A 3-drug regimen with olanzapine represents a valid option in a limited resource context.
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Affiliation(s)
- Marco Filetti
- Phase 1 Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Pasquale Lombardi
- Phase 1 Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Raffaele Giusti
- Medical Oncology Unit, Sant'Andrea Hospital of Rome, Rome, Italy
| | - Rosa Falcone
- Phase 1 Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Florian Scotte
- Interdisciplinary Cancer Course Division Gustave Roussy, Paris, France
| | - Diana Giannarelli
- Biostatistics Unit, Scientific Directorate, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Antonella Carcagnì
- Biostatistics Unit, Scientific Directorate, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Valeria Altamura
- Phase 1 Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Giovanni Scambia
- Scientific Directorate, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Department of Life Science and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Gennaro Daniele
- Phase 1 Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy.
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Tyler T, Schultz A, Venturini A, Giuliano C, Bernareggi A, Spezia R, Voisin D, Stella V. Challenges in the Development of Intravenous Neurokinin-1 Receptor Antagonists: Results of a Safety and Pharmacokinetics Dose-Finding, Phase 1 Study of Intravenous Fosnetupitant. Clin Pharmacol Drug Dev 2022; 11:1405-1418. [PMID: 36263927 PMCID: PMC10092591 DOI: 10.1002/cpdd.1183] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 09/18/2022] [Indexed: 01/28/2023]
Abstract
Oral NEPA is the fixed-combination antiemetic comprising netupitant (neurokinin-1 receptor antagonist [NK1 RA]) and palonosetron (5-hydroxytryptamine-3 receptor antagonist [5-HT3 RA]). Intravenous (IV) NEPA, containing fosnetupitant, a water-soluble N-phosphoryloxymethyl prodrug of netupitant, has been developed. Fosnetupitant does not require excipients or solubility enhancers often used to increase IV NK1 RA water solubility, preventing the occurrence of hypersensitivity and infusion-site reactions associated with these products. In this phase 1 study, subjects received a 30-minute placebo or fosnetupitant (17.6-353 mg) infusion and an oral NEPA or placebo capsule, with 2-sequence crossover treatment for fosnetupitant 118- to 353-mg dose cohorts. IV fosnetupitant safety and pharmacokinetics were evaluated, and its equivalence to an oral netupitant 300-mg dose was defined. Overall, 158 healthy volunteers were enrolled. All adverse events (AEs) were mild or moderate in intensity. Doppler-identified infusion-site asymptomatic thrombosis occurred in 5.4% (fosnetupitant) and 1.2% (oral NEPA) of subjects. The frequency or number of treatment-related AEs did not increase with ascending fosnetupitant doses. The most common treatment-related AEs were headache (fosnetupitant, 8.1%; oral NEPA, 12.7%) and constipation (fosnetupitant, 1.4%; oral NEPA, 7.5%). A fosnetupitant 235-mg dose was equivalent, in terms of netupitant exposure, to 300-mg oral netupitant. The safety profile of a single fosnetupitant 235-mg infusion was similar to that of single-dose oral NEPA.
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Affiliation(s)
- Timothy Tyler
- Comprehensive Cancer Center, Desert Regional Medical Center, Palm Springs, California, USA
| | - Armin Schultz
- CRS Clinical Research Services Mannheim GmbH, Mannheim, Germany
| | | | | | | | | | | | - Valentino Stella
- Pharmaceutical Chemistry, The University of Kansas, Lawrence, Kansas, USA
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Approach the prevention of chemotherapy-induced nausea and vomiting in older patients with care. DRUGS & THERAPY PERSPECTIVES 2022. [DOI: 10.1007/s40267-022-00952-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Hata A, Okamoto I, Inui N, Okada M, Morise M, Akiyoshi K, Takeda M, Watanabe Y, Sugawara S, Shinagawa N, Kubota K, Saeki T, Tamura T. Randomized, Double-Blind, Phase III Study of Fosnetupitant Versus Fosaprepitant for Prevention of Highly Emetogenic Chemotherapy-Induced Nausea and Vomiting: CONSOLE. J Clin Oncol 2022; 40:180-188. [PMID: 34793245 PMCID: PMC8718175 DOI: 10.1200/jco.21.01315] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
PURPOSE We evaluated the efficacy and safety of fosnetupitant (FosNTP) versus fosaprepitant (FosAPR) for preventing highly emetogenic chemotherapy-induced nausea and vomiting. This phase III study was the first head-to-head comparison between two different neurokinin-1 receptor antagonists in combination with palonosetron and dexamethasone. PATIENTS AND METHODS Patients scheduled to receive cisplatin-based chemotherapy were randomly assigned 1:1 to FosNTP 235 mg or FosAPR 150 mg in combination with palonosetron 0.75 mg and dexamethasone. The primary end point was overall (0-120 hours) complete response (CR; no emetic event and no rescue medication) rate, stratified by sex and age category, to show the noninferiority of FosNTP to FosAPR (noninferiority margin, -10% for the difference in the overall CR rate). RESULTS Overall, 795 patients were randomly assigned, of whom 785 received the study drug (FosNTP [N = 392] v FosAPR [N = 393]) and were evaluated for efficacy and safety. The overall CR rate was 75.2% versus 71.0%, respectively (Mantel-Haenszel common risk difference, 4.1%; 95% CI, -2.1% to 10.3%), demonstrating noninferiority of FosNTP to FosAPR. The CR rates in the acute (0-24 hours), delayed (24-120 hours), and beyond delayed (120-168 hours) phases, and at 0-168 hours were 93.9% versus 92.6%, 76.8% versus 72.8%, 86.5% versus 81.4%, and 73.2% versus 66.9%, respectively. The incidence rates of treatment-related adverse events with FosNTP versus FosAPR were 22.2% versus 25.4%, whereas adverse events or treatment-related adverse events relevant to injection site reactions were 11.0% versus 20.6% (P < .001) and 0.3% versus 3.6% (P < .001), respectively. CONCLUSION FosNTP demonstrated noninferiority to FosAPR, with a favorable safety profile and lower risk for injection site reactions. Thus, FosNTP is valuable in the prophylaxis of acute, delayed, and beyond delayed chemotherapy-induced nausea and vomiting.
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Affiliation(s)
- Akito Hata
- Department of Thoracic Oncology, Kobe Minimally Invasive Cancer Center, Kobe, Japan,Akito Hata, MD, Department of Thoracic Oncology, Kobe Minimally Invasive Cancer Center, 8-5-1 Minatojima-minamimachi, Chuo-ku, Kobe, Hyogo 650-0047, Japan; e-mail:
| | - Isamu Okamoto
- Research Institute for Diseases of the Chest, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Naoki Inui
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Morihito Okada
- Department of Surgical Oncology, Hiroshima University, Hiroshima, Japan
| | - Masahiro Morise
- Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kohei Akiyoshi
- Department of Clinical Oncology, Osaka City General Hospital, Osaka, Japan
| | - Masayuki Takeda
- Department of Medical Oncology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
| | - Yasutaka Watanabe
- Department of Thoracic Oncology, Saitama Cancer Center, Saitama, Japan
| | - Shunichi Sugawara
- Department of Pulmonary Medicine, Sendai Kousei Hospital, Sendai, Japan
| | - Naofumi Shinagawa
- Department of Respiratory Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Kaoru Kubota
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Toshiaki Saeki
- Department of Breast Oncology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Tomohide Tamura
- Thoracic Center, St Luke's International Hospital, Tokyo, Japan
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Herrstedt J, Lindberg S, Petersen PC. Prevention of Chemotherapy-Induced Nausea and Vomiting in the Older Patient: Optimizing Outcomes. Drugs Aging 2021; 39:1-21. [PMID: 34882284 PMCID: PMC8654643 DOI: 10.1007/s40266-021-00909-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2021] [Indexed: 11/25/2022]
Abstract
Chemotherapy-induced nausea and vomiting (CINV) are still two of the most feared side effects of cancer therapy. Although major progress in the prophylaxis of CINV has been made during the past 40 years, nausea in particular remains a significant problem. Older patients have a lower risk of CINV than younger patients, but are at a higher risk of severe consequences of dehydration and electrolyte disturbances following emesis. Age-related organ deficiencies, comorbidities, polypharmacy, risk of drug–drug interactions, and lack of compliance all need to be addressed in the older patient with cancer at risk of CINV. Guidelines provide evidence-based recommendations for the prophylaxis of CINV, but none of these guidelines offer specific recommendations for older patients with cancer. This means that the recommendations may lead to overtreatment in some older patients. This review describes the development of antiemetic prophylaxis of CINV focusing on older patients, summarizes recommendations from antiemetic guidelines, describes deficiencies in our knowledge of older patients, summarizes necessary precautions, and suggests some future perspectives for antiemetic research in older patients.
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Affiliation(s)
- Jørn Herrstedt
- Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Roskilde and Næstved, Sygehusvej 10, 4000, Roskilde, Denmark. .,Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
| | - Sanne Lindberg
- Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Roskilde and Næstved, Sygehusvej 10, 4000, Roskilde, Denmark
| | - Peter Clausager Petersen
- Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Roskilde and Næstved, Sygehusvej 10, 4000, Roskilde, Denmark
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Shirley M. Netupitant/Palonosetron: A Review in Chemotherapy-Induced Nausea and Vomiting. Drugs 2021; 81:1331-1342. [PMID: 34292534 PMCID: PMC8463343 DOI: 10.1007/s40265-021-01558-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2021] [Indexed: 10/26/2022]
Abstract
Netupitant/palonosetron (NEPA; Akynzeo®), available in oral and intravenous (IV) formulations, is a fixed-dose combination of the neurokinin 1 (NK1) receptor antagonist netupitant (or the prodrug, fosnetupitant, in the IV formulation) and the second-generation serotonin 3 (5-HT3) receptor antagonist palonosetron. Administered as a single dose, (fos)netupitant/palonosetron (in combination with dexamethasone) is indicated for the prevention of acute and delayed chemotherapy-induced nausea and vomiting (CINV) in adults. In clinical trials, (fos)netupitant/palonosetron plus dexamethasone was associated with high complete response rates (no emesis and no rescue medication) in the acute, delayed and overall phases in patients receiving highly or moderately emetogenic chemotherapy, with efficacy maintained over multiple cycles. Further, oral netupitant/palonosetron was found to be superior to palonosetron and non-inferior to aprepitant plus granisetron in preventing CINV in individual trials. Both the oral and IV formulations of the drug combination are well tolerated. The fixed-dose combination is concordant with guideline recommendations and provides a simple and convenient option for prophylaxis against acute and delayed CINV in patients receiving highly or moderately emetogenic chemotherapy.
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Affiliation(s)
- Matt Shirley
- Springer Nature, Private Bag 65901, Mairangi Bay, Auckland, 0754, New Zealand.
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11
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Aapro M, Navari RM, Roeland E, Zhang L, Schwartzberg L. Efficacy of intravenous NEPA, a fixed NK 1/5-HT 3 receptor antagonist combination, for the prevention of chemotherapy-induced nausea and vomiting (CINV) during cisplatin- and anthracycline cyclophosphamide (AC)-based chemotherapy: A review of phase 3 studies. Crit Rev Oncol Hematol 2020; 157:103143. [PMID: 33260048 DOI: 10.1016/j.critrevonc.2020.103143] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 10/20/2020] [Accepted: 10/21/2020] [Indexed: 11/25/2022] Open
Abstract
This paper presents an overview of the efficacy of intravenous (IV) NEPA (fixed combination of the NK1RA, fosnetupitant, and 5-HT3RA, palonosetron) relative to oral NEPA and also to historical data for other NK1RA regimens. Data is compiled from 5 pivotal NEPA studies in adult chemotherapy-naïve patients with solid tumors undergoing either cisplatin- or anthracycline cyclophosphamide (AC)-based chemotherapy. Additionally, data was reviewed from 10 pivotal Phase 3 studies utilizing other NK1RA regimens approved for clinical use. The overall (0-120 h) complete response (no emesis, no rescue use), no emesis, and no significant nausea rates for IV NEPA were similar to that of oral NEPA and were consistently numerically higher than historical NK1RA regimens. As a single-dose prophylactic antiemetic combination given with dexamethasone, IV NEPA is a highly effective and convenient guideline-compliant antiemetic agent which may offer a safety benefit over other IV NK1RA regimens due to its lack of associated hypersensitivity and injection-site reactions.
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Affiliation(s)
- Matti Aapro
- Genolier Cancer Center, Clinique de Genolier, Case Postale 100, Route du Muids, Genolier, Switzerland.
| | - Rudolph M Navari
- Division of Hematology/Oncology, North Pavillion 2540K, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, United States
| | - Eric Roeland
- Oncology & Palliative Care, Massachusetts General Hospital Cancer Center, 55 Fruit Street, Boston, Massachusetts, United States
| | - Li Zhang
- Sun Yat-sen University Cancer Center, 651 Dongfeng East Road, Guangzhou City, Guangdong Province, China
| | - Lee Schwartzberg
- Hematology & Oncology, West Cancer Center & Research Institute, 7945 Wolf River Boulevard, Germantown, Tennessee, United States
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Karthaus M, Voisin D, Rizzi G, Ciuleanu T. Phase 3 Study of Palonosetron IV Infusion Vs. IV Bolus for Chemotherapy-Induced Nausea and Vomiting Prophylaxis After Highly Emetogenic Chemotherapy. J Pain Symptom Manage 2020; 60:568-576. [PMID: 32276098 DOI: 10.1016/j.jpainsymman.2020.03.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 03/24/2020] [Accepted: 03/27/2020] [Indexed: 10/24/2022]
Abstract
CONTEXT Palonosetron (PALO) is one of the two active components of NEPA, the fixed-combination antiemetic comprising netupitant (oral)/fosnetupitant (IV) and PALO. To increase the convenience of NEPA administration, especially for patients with swallowing difficulties, an IV NEPA formulation has been developed, where PALO is administered as a 30-minute infusion instead of the approved 30-second bolus. OBJECTIVES To determine the efficacy and safety of the PALO component used in IV NEPA. METHODS Noninferiority, double-blind, and randomized Phase 3 trial in chemotherapy-naive adult patients with cancer requiring highly emetogenic chemotherapy. Patients were randomized to receive a single dose of PALO 0.25 mg administered IV either as a 30-minute infusion or as a 30-second bolus before highly emetogenic chemotherapy. The primary objective was to demonstrate noninferiority of the 30-minute infusion vs. 30-second bolus in terms of complete response (CR; no emesis and no rescue medication) in the acute phase. Secondary efficacy endpoints were CR in the delayed and overall phases and no emesis and no rescue medication in all phases. Safety was a secondary endpoint. RESULTS Overall, 440 patients received study treatment. In the infusion group, 186 (82.7%) patients reported CR in the acute phase vs. 186 (86.5%) patients in the bolus group, demonstrating the noninferiority of PALO infusion vs. bolus (P < 0.001). Secondary endpoints showed similar results between the two treatment groups. CONCLUSION PALO 0.25-mg 30-minute IV infusion was noninferior to 30-second IV bolus in terms of CR rate in the acute phase. These results support the use of PALO 0.25 mg as a component of IV NEPA.
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Affiliation(s)
- Meinolf Karthaus
- Department of Hematology and Oncology, Klinikum Neuperlach/Klinikum Harlaching, Munich, Germany.
| | | | - Giada Rizzi
- Helsinn Healthcare SA, Lugano, Switzerland; Chiesi Farmaceutici SpA, Parma, Italy
| | - Tudor Ciuleanu
- Institute of Oncology Prof. Dr. Ion Chiricuţã and UMF Iuliu Haţieganu, Cluj-Napoca, Romania
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Karthaus M, Oskay-Özcelik G, Wülfing P, Hielscher C, Guth D, Zahn MO, Flahaut E, Schilling J. Real-world evidence of NEPA, netupitant-palonosetron, in chemotherapy-induced nausea and vomiting prevention: effects on quality of life. Future Oncol 2020; 16:939-953. [DOI: 10.2217/fon-2020-0187] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Aim: To determine quality of life, effectiveness and safety of oral netupitant-palonosetron (NEPA)–based antiemetic prophylaxis in the real-world setting. Materials & methods: Prospective, noninterventional study in adults receiving highly or moderately emetogenic chemotherapy and NEPA for three cycles. NEPA was administered per summary of product characteristics. Results: A total of 2429 patients enrolled, 2173 were evaluable. ‘No impact on daily life’ due to vomiting was reported by 84%/82% of patients in the highly emetogenic chemotherapy/moderately emetogenic chemotherapy groups in cycle 1, with rates of 54%/59% for nausea. Overall, complete response rate was 89%/87%/83% in the acute/delayed/overall phases. NEPA was well tolerated. Conclusion: NEPA had beneficial effects on the quality of life of a heterogeneous group of cancer patients and was safe and effective in the real-world setting.
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Affiliation(s)
- Meinolf Karthaus
- Department of Hematology, Oncology & Palliative Care, Klinikum Neuperlach, Munich, Germany
- Department of Hematology, Oncology & Palliative Care, Klinikum Harlaching, Munich, Germany
| | | | - Pia Wülfing
- Mammazentrum Hamburg am Krankenhaus Jerusalem, Hamburg, Germany
| | | | - Dagmar Guth
- Gynecological Oncology Practice, Plauen, Germany
| | | | - Elisa Flahaut
- Department of Medical Affairs, RIEMSER Pharma GmbH, Berlin, Germany
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Schwartzberg L, Navari R, Clark‐Snow R, Arkania E, Radyukova I, Patel K, Voisin D, Rizzi G, Wickham R, Gralla RJ, Aapro M, Roeland E. Phase IIIb Safety and Efficacy of Intravenous NEPA for Prevention of Chemotherapy-Induced Nausea and Vomiting (CINV) in Patients with Breast Cancer Receiving Initial and Repeat Cycles of Anthracycline and Cyclophosphamide (AC) Chemotherapy. Oncologist 2020; 25:e589-e597. [PMID: 32162813 PMCID: PMC7066686 DOI: 10.1634/theoncologist.2019-0527] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Accepted: 11/01/2019] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND NEPA, a combination antiemetic of a neurokinin-1 (NK1 ) receptor antagonist (RA) (netupitant [oral]/fosnetupitant [intravenous; IV]) and 5-HT3 RA, palonosetron] offers 5-day CINV prevention with a single dose. Fosnetupitant solution contains no allergenic excipients, surfactant, emulsifier, or solubility enhancer. A phase III study of patients receiving cisplatin found no infusion-site or anaphylactic reactions related to IV NEPA. However, hypersensitivity reactions and anaphylaxis have been reported with other IV NK1 RAs, particularly fosaprepitant in patients receiving anthracycline-cyclophosphamide (AC)-based chemotherapy. This study evaluated the safety and efficacy of IV NEPA in the AC setting. MATERIALS AND METHODS This phase IIIb, multinational, randomized, double-blind study enrolled females with breast cancer naive to highly or moderately emetogenic chemotherapy. Patients were randomized to receive a single 30-minute infusion of IV NEPA or single oral NEPA capsule on day 1 prior to AC, in repeated (up to 4) cycles. Oral dexamethasone was given to all patients on day 1 only. RESULTS A total of 402 patients were included. The adverse event (AE) profiles were similar for IV and oral NEPA and consistent with those expected. Most AEs were mild or moderate with a similarly low incidence of treatment-related AEs in both groups. There were no treatment-related injection-site AEs and no reports of hypersensitivity or anaphylaxis. The efficacy of IV and oral NEPA were similar, with high complete response (no emesis/no rescue) rates observed in cycle 1 (overall [0-120 hours] 73.0% IV NEPA, 77.3% oral NEPA) and maintained over subsequent cycles. CONCLUSION IV NEPA was highly effective and safe with no associated hypersensitivity and injection-site reactions in patients receiving AC. IMPLICATIONS FOR PRACTICE As a combination of a neurokinin-1 (NK1 ) receptor antagonist (RA) and 5-HT3 RA, NEPA offers 5-day chemotherapy-induced nausea and vomiting prevention with a single dose and an opportunity to improve adherence to antiemetic guidelines. In this randomized multinational phase IIIb study, intravenous (IV) NEPA (fosnetupitant/palonosetron) was safe and highly effective in patients receiving multiple cycles of anthracycline-cyclophosphamide (AC)-based chemotherapy. Unlike other IV NK1 RAs, the IV NEPA combination solution does not require any surfactant, emulsifier, or solubility enhancer and contains no allergenic excipients. Hypersensitivity reactions and anaphylaxis have been reported with other IV NK1 RAs, most commonly with fosaprepitant in the AC setting. Importantly, there were no injection-site or hypersensitivity reactions associated with IV NEPA.
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Affiliation(s)
| | - Rudolph Navari
- Department of Hematology/Oncology, University of Alabama at BirminghamBirminghamAlabamaUSA
| | | | | | - Irena Radyukova
- Department of Chemotherapy, Clinical Oncology CenterOmskRussia
| | | | | | | | | | - Richard J. Gralla
- Department of Medical Oncology, Albert Einstein College of MedicineBronxNew YorkUSA
| | - Matti Aapro
- Cancer Centre, Clinique de GenolierGenolierSwitzerland
| | - Eric Roeland
- Oncology & Palliative Care, Massachusetts General Hospital Cancer CenterBostonMassachusettsUSA
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Sugawara S, Inui N, Kanehara M, Morise M, Yoshimori K, Kumagai T, Fukui T, Minato K, Iwashima A, Takeda Y, Kubota K, Saeki T, Tamura T. Multicenter, placebo-controlled, double-blind, randomized study of fosnetupitant in combination with palonosetron for the prevention of chemotherapy-induced nausea and vomiting in patients receiving highly emetogenic chemotherapy. Cancer 2019; 125:4076-4083. [PMID: 31381152 PMCID: PMC6900104 DOI: 10.1002/cncr.32429] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 07/02/2019] [Accepted: 07/05/2019] [Indexed: 11/26/2022]
Abstract
Background The current randomized, double‐blind, phase 2 study assessed the efficacy and safety profile of a single intravenous administration of fosnetupitant, a neurokinin 1 receptor antagonist prodrug, for the prevention of chemotherapy‐induced nausea and vomiting in Japanese patients receiving cisplatin‐based chemotherapy. Methods Patients scheduled to receive cisplatin (at a dose of ≥70 mg/m2)‐based regimens were randomly assigned to receive fosnetupitant at a dose of 81 mg or 235 mg or placebo in combination with palonosetron at a dose of 0.75 mg and dexamethasone. The primary endpoint was complete response (CR; no vomiting and no rescue medication) during the overall phase (0‐120 hours). The overall CR rate was compared between each dose of fosnetupitant and the placebo group adjusting for the stratification factors of sex and age class (age <55 years vs age ≥55 years). Safety was assessed, with special attention given to events that potentially were suggestive of infusion site reactions. Results A total of 594 patients were randomized. Of these, 194 patients, 195 patients, and 195 patients, respectively, in the placebo and fosnetupitant 81‐mg and 235‐mg dose groups were evaluable for efficacy. The overall CR rate was 54.7% for the placebo group, 63.8% for the fosnetupitant 81‐mg dose group (adjusted difference, 9.1%; 95% CI, ‐0.4% to 18.6% [P = .061]), and 76.8% for the fosnetupitant 235‐mg dose group (adjusted difference, 22.0%; 97.5% CI, 11.7% to 32.3% [P < .001]). Safety profiles were comparable between the 3 groups. The incidence of infusion site reactions related to fosnetupitant was ≤1% in each dose group. Conclusions Fosnetupitant at a dose of 235 mg provided superior prevention of chemotherapy‐induced nausea and vomiting among patients receiving cisplatin‐based chemotherapy compared with the control group, and with a satisfactory safety profile. Fosnetupitant at a dose of 235 mg combined with palonosetron and dexamethasone was demonstrated to be effective in the prevention of emesis during the first 0 to 120 hours after the administration of cisplatin. The results of the current study suggest that fosnetupitant at a dose of 235 mg also may improve the percentage of patients with no nausea in the delayed phase (24 ‐ 120 hours after cisplatin administration), which is an unmet medical need of patients with cancer who are receiving chemotherapy.
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Affiliation(s)
- Shunichi Sugawara
- Department of Pulmonary Medicine, Sendai Kousei Hospital, Miyagi, Japan
| | - Naoki Inui
- Respiratory Medicine, Hamamatsu University School of Medicine, Shizuoka, Japan
| | - Masashi Kanehara
- Department of Respiratory Medicine, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Masahiro Morise
- Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Kozo Yoshimori
- Department of Clinical Oncology, Fukujuji Hospital, Tokyo, Japan
| | - Toru Kumagai
- Department of Thoracic Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Tomoya Fukui
- Department of Respiratory Medicine, Kitasato University School of Medicine, Kanagawa, Japan
| | - Koichi Minato
- Division of Respiratory Medicine, Gunma Prefectural Cancer Center, Gunma, Japan
| | - Akira Iwashima
- Department of Respiratory Medicine, Nagaoka Chuo General Hospital, Niigata, Japan
| | - Yuichiro Takeda
- Department of Respiratory Medicine, National Center for Global Health and Medicine, Tokyo, Japan
| | - Kaoru Kubota
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Toshiaki Saeki
- Department of Breast Oncology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Tomohide Tamura
- Thoracic Center, St. Luke's International Hospital, Tokyo, Japan
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Kurteva G, Chilingirova N, Rizzi G, Caccia T, Stella V, Bernareggi A. Pharmacokinetic profile and safety of intravenous NEPA, a fixed combination of fosnetupitant and palonosetron, in cancer patients: Prevention of chemotherapy-induced nausea and vomiting associated with highly emetogenic chemotherapy. Eur J Pharm Sci 2019; 139:105041. [PMID: 31404621 DOI: 10.1016/j.ejps.2019.105041] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 08/07/2019] [Accepted: 08/07/2019] [Indexed: 10/26/2022]
Abstract
NEPA is the fixed combination antiemetic composed of the neurokinin-1 receptor antagonist netupitant and the 5-hydroxytryptamine-3 receptor antagonist palonosetron. The intravenous (i.v.) formulation of NEPA (fosnetupitant 235 mg/palonosetron 0.25 mg) was developed to enhance the convenience of NEPA administration. In a phase 3 study, i.v. NEPA showed acceptable safety with low risk for injection-site reactions. This study evaluated the pharmacokinetics and safety of i.v. NEPA in cancer patients. This was a single-center, single-dose phase 1 study in patients receiving highly emetogenic chemotherapy. Patients received a 30-min infusion of i.v. NEPA plus oral dexamethasone (12 mg) prior to chemotherapy, and oral dexamethasone (8 mg/daily) on days 2-4. Twenty-four patients received the complete i.v. NEPA infusion volume. Fosnetupitant maximum plasma concentration (Cmax) was reached at the end of infusion and decreased to <1% of Cmax 30 min later. Netupitant was rapidly released from its prodrug and Cmax of 590 ng/ml was reached at the end of fosnetupitant infusion, with a mean exposure (AUC∞) of 15,588 h∙ng/ml. Palonosetron Cmax was reached at the end of infusion, with a mean AUC∞ of 36.07 h∙ng/ml. The most common adverse events were constipation (29%), nausea (17%), and vasospasm (8%). No i.v. NEPA-related injection site reactions occurred. Fosnetupitant conversion to netupitant occurred rapidly in cancer patients. Netupitant and palonosetron pharmacokinetic profiles in i.v. NEPA were similar to those reported for oral NEPA. i.v. NEPA was well tolerated with a similar safety profile to oral NEPA. i.v. NEPA provides additional administration convenience. Clinical trial registration number: EudraCT 2015-004750-18.
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Affiliation(s)
- Galina Kurteva
- University Specialized Hospital for Active Treatment in Oncology, Medical Oncology Clinic, 6 Plovdivsko Pole str., 1756 Sofia, Bulgaria.
| | - Nataliya Chilingirova
- University Specialized Hospital for Active Treatment in Oncology, Medical Oncology Clinic, 6 Plovdivsko Pole str., 1756 Sofia, Bulgaria; Medical University Pleven, 1 Sveti Kliment Ohridski str., 5800 Pleven, Bulgaria.
| | - Giada Rizzi
- Helsinn Healthcare SA, Via Pian Scairolo 9, 6912 Pazzallo (Lugano), Switzerland.
| | - Tatiana Caccia
- Helsinn Healthcare SA, Via Pian Scairolo 9, 6912 Pazzallo (Lugano), Switzerland.
| | - Valentino Stella
- Department of Pharmaceutical Chemistry, University of Kansas, Simons Biosciences Research Laboratories, 2095 Constant Ave, Lawrence, KS 66047, USA.
| | - Alberto Bernareggi
- Helsinn Healthcare SA, Via Pian Scairolo 9, 6912 Pazzallo (Lugano), Switzerland.
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Jordan K. New formulation, new drug? The importance of assessing the safety of new supportive care formulations in oncology. Ann Oncol 2019; 29:1494-1496. [PMID: 29790903 DOI: 10.1093/annonc/mdy187] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- K Jordan
- Department of Medicine V, Hematology, Oncology and Rheumatology, University of Heidelberg, Heidelberg, Germany.
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Karthaus M, Schiel X, Ruhlmann CH, Celio L. Neurokinin-1 receptor antagonists: review of their role for the prevention of chemotherapy-induced nausea and vomiting in adults. Expert Rev Clin Pharmacol 2019; 12:661-680. [PMID: 31194593 DOI: 10.1080/17512433.2019.1621162] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Introduction: The addition of neurokinin-1 receptor antagonists (NK1RAs) to standard prophylaxis of 5-hydroxytryptamine-3 RA (5-HT3RA) plus dexamethasone more effectively prevents chemotherapy-induced nausea and vomiting (CINV) associated with highly and moderately emetogenic chemotherapy. Areas covered: This review presents the evidence base for the use of oral and intravenous (IV) NK1RAs, focusing on the pharmacologic and clinical properties as a class, and highlighting differences between agents. A PubMed literature search was conducted from 2000 to 2018. Expert opinion: Adherence to international antiemetic guidelines remains a clinical challenge. Strategies to simplify antiemetic regimens and facilitate their administration may improve compliance and treatment outcomes. The use of fixed-combination antiemetics offers clinical utility, in combining an NK1RA with a 5-HT3RA in a single oral dose. The use of long-lasting NK1RAs and administering CINV prophylaxis closer to the time of chemotherapy may also assist with guideline and treatment compliance, diminishing the need for home-based administration, and potentially reducing resource utilization. The availability of IV and oral formulations of NK1RAs and NK1RA-5-HT3RA fixed combinations offers further utility, particularly for those patients unsuited for oral administration. However, safety considerations with respect to injection site toxicity and hypersensitivity reactions of the new NK1RA IV formulations deserve close attention.
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Affiliation(s)
- Meinolf Karthaus
- a Department of Hematology, Oncology and Palliative Care , Klinikum Neuperlach , Munich , Germany.,b Department of Hematology, Oncology and Palliative Care , Klinikum Harlaching , Munich , Germany
| | - Xaver Schiel
- b Department of Hematology, Oncology and Palliative Care , Klinikum Harlaching , Munich , Germany
| | | | - Luigi Celio
- d Department of Medical Oncology and Hematology , Fondazione IRCCS Istituto Nazionale dei Tumori , Milan , Italy
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Aapro M, Zhang L, Yennu S, LeBlanc TW, Schwartzberg L. Preventing chemotherapy-induced nausea and vomiting with netupitant/palonosetron, the first fixed combination antiemetic: current and future perspective. Future Oncol 2019; 15:1067-1084. [PMID: 30860400 DOI: 10.2217/fon-2018-0872] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Chemotherapy-induced nausea and vomiting (CINV) can be prevented in most patients receiving appropriate antiemetic treatment. However, inadequate uptake of current antiemetic guideline recommendations by physicians, and poor treatment adherence by patients, lead to suboptimal CINV control. There is an unmet need to optimize guideline-consistent use of antiemetics to improve CINV management and prevention. Herein, we provide an overview of CINV, then discuss oral and intravenous NEPA, the first fixed combination antiemetic, composed of netupitant/fosnetupitant and palonosetron. We describe the main pharmacologic and pharmacokinetic characteristics of NEPA, and review the clinical evidence supporting its use in the prevention of CINV.
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Affiliation(s)
- Matti Aapro
- Genolier Cancer Centre, Clinique de Genolier, Genolier, Switzerland
| | - Li Zhang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Department of Medical Oncology Sun Yat-sen University Cancer Center, Guangzhou, PR China
| | - Sriram Yennu
- Department of Palliative, Rehabilitation and Integrative Medicine, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Thomas W LeBlanc
- Division of Hematologic Malignancies and Cellular Therapy, Duke University School of Medicine, Durham, NC 27705, USA
| | - Lee Schwartzberg
- Department of Hematology and Oncology, The West Clinic, Germantown, TN 38138, USA
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Navari RM, Schwartzberg LS. Evolving role of neurokinin 1-receptor antagonists for chemotherapy-induced nausea and vomiting. Onco Targets Ther 2018; 11:6459-6478. [PMID: 30323622 PMCID: PMC6178341 DOI: 10.2147/ott.s158570] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
To examine pharmacologic and clinical characteristics of neurokinin 1 (NK1)-receptor antagonists (RAs) for preventing chemotherapy-induced nausea and vomiting (CINV) following highly or moderately emetogenic chemotherapy, a literature search was performed for clinical studies in patients at risk of CINV with any approved NK1 RAs in the title or abstract: aprepitant (capsules or oral suspension), HTX019 (intravenous [IV] aprepitant), fosaprepitant (IV aprepitant prodrug), rolapitant (tablets or IV), and fixed-dose tablets combining netupitant or fosnetupi-tant (IV netupitant prodrug) with the 5-hydroxytryptamine type 3 (5HT3) RA palonosetron (oral or IV). All NK1 RAs are effective, but exhibit important differences in efficacy against acute and delayed CINV. The magnitude of benefit of NK1-RA-containing three-drug vs two-drug regimens is greater for delayed vs acute CINV. Oral rolapitant has the longest half-life of available NK1 RAs, but as a consequence should not be administered more frequently than every 2 weeks. In general, NK1 RAs are well tolerated; however, IV rolapitant was recently removed from US distribution, due to hypersensitivity and anaphylaxis, and IV fosaprepitant is associated with infusion-site reactions and hypersensitivity presumed related to its polysorbate 80 excipient. Also, available NK1 RAs have potential drug–drug interactions. Adding an NK1 RA to 5HT3 RA and dexamethasone significantly improves CINV control vs the two-drug regimen. Newer NK1 RAs offer more formulation options, higher acute-phase plasma levels, or improved tolerability, and increase clinicians’ opportunities to maximize benefits of this important class of antiemetics.
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Affiliation(s)
- Rudolph M Navari
- Department of Hematology/ Oncology, University of Alabama at Birmingham, Birmingham, AL, USA,
| | - Lee S Schwartzberg
- Division of Hematology/Oncology, Department of Medicine, University of Tennessee Health Science Center and West Cancer Center, Memphis, TN, USA
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Celio L, Fabbroni C. Pro-netupitant/palonosetron (IV) for the treatment of radio-and-chemotherapy-induced nausea and vomiting. Expert Opin Pharmacother 2018; 19:1267-1277. [DOI: 10.1080/14656566.2018.1494726] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Luigi Celio
- Medical Oncology Unit 1, Department of Medical Oncology and Hematology, Fondazione IRCCS “Istituto Nazionale dei Tumori”, Milan, Italy
| | - Chiara Fabbroni
- Medical Oncology Unit 1, Department of Medical Oncology and Hematology, Fondazione IRCCS “Istituto Nazionale dei Tumori”, Milan, Italy
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