Netupitant 300mg / Palonosetron hydrochloride 500micrograms capsules

This systematic review critically evaluates the comparative efficacy of novel and traditional antiemetic agents in preventing chemotherapy-induced nausea and vomiting (CINV) in patients receiving moderate or highly emetogenic chemotherapy (MEC/HEC). The findings suggest that novel agents, such as netupitant/palonosetron (NEPA), olanzapine, and transdermal granisetron (GTDS), offer comparable or superior efficacy to traditional antiemetic regimens, including standard options like aprepitant combined with 5-HT₃ receptor antagonists and corticosteroids. These novel agents demonstrate strong effectiveness in controlling both acute and delayed CINV and offer practical advantages, such as simplified dosing regimens and improved patient adherence, particularly in resource-limited settings. Additionally, traditional regimens incorporating aprepitant remain effective in preventing CINV. However, the review highlights the need for more direct comparisons between novel and traditional agents, as well as further studies evaluating novel therapies in real-world clinical settings. Future research should focus on larger, long-term trials to better establish the role of novel antiemetic agents and optimize CINV management strategies.

Abstract licence: CC BY

BackgroundThe effectiveness of a dexamethasone-sparing strategy in the treatment of breast cancer with anthracycline-cyclophosphamide therapy when combined with first-generation 5-HT3 receptor antagonists (RAs) and neurokinin-1 RAs is unclear. This is attributable to a lack of evidence from direct comparison of multiple doses of DEX to a single dose of DEX in combination with first-generation 5-HT3 RAs in anthracycline-cyclophosphamide therapy. Our goal was to clarify the impact of dexamethasone-sparing strategies that involve both first-generation 5-HT3 RAs and palonosetron when combined with neurokinin-1 RAs, using a network meta-analysis.Materials and methodsA literature search was conducted on PubMed/Medline for articles published up to July 4, 2023. We included randomized controlled trials which assessed the efficacy of antiemetic regimens which combined 5-HT3 RAs and dexamethasone, with or without neurokinin-1 RAs, for the initial dose in anthracycline-cyclophosphamide therapy for patients with breast cancer. The primary outcome was the proportion of patients achieving a complete response during the delayed phase (CR-DP).ResultsThe difference in the proportion of patients achieving CR-DP between multiple and single doses of dexamethasone was 0.1% (95%CI: -12.4 to 12.5) with palonosetron and neurokinin-1 RAs, compared to 5.3% (95%CI: -13.4 to 23.0) with a single dose of a first-generation 5-HT3 receptor antagonist. Additionally, the difference was 12.7% (95% CI: -2.8 to 28.2) when comparing palonosetron against first-generation 5-HT3 RAs in combination with a single dose of dexamethasone and neurokinin-1 RAs.ConclusionPalonosetron is recommended rather than a single dose of first-generation 5-HT3 RAs in dexamethasone-sparing strategies for anthracycline-cyclophosphamide therapy.

Abstract licence: CC BY