Netupitant/palonosetron combination in prevention of chemotherapy-induced nausea and vomiting in patients with bladder cancer

Introduction . Chemotherapy-induced nausea and vomiting remain among the most unpleasant and dangerous side effects. Netupitant/palonosetron (Akynzeo) is an effective and convenient combination therapy for the prevention of nausea and vomiting in patients receiving chemotherapy with moderate to high emetogenic potential. Aim . To evaluate the efficacy of clinically used regimens for the prevention of nausea and vomiting associated with highly emetogenic antitumor chemotherapy for bladder cancer (netupitant/palonosetron and aprepitant/ondansetron). Materials and methods . We prospectively analyzed the experience of concomitant antiemetic therapy in 47 patients receiving gemcitabine-cisplatin antitumor chemotherapy for urothelial carcinoma of the bladder. Response rates were calculated in the acute (0–24 h), delayed (24–120 h), and overall phases of the first GC cycle. Results and discussion . Complete response rates with oral netupitant/palonosetron and aprepitant/ondansetron were 86.9% and 87.5% in the acute (p = 0.2), 82.6% and 75.0% in the delayed (p = 0.02), and 78.3% and 70.8% in the overall (p = 0.04) phases, respectively. Breakthrough vomiting within 120 hours after cisplatin administration occurred in 17.4% of patients in the netupitant/palonosetron group and 20.8% in the aprepitant/ondansetron group (p = 0.25). All cases of breakthrough vomiting developed between days 3 and 5. The incidence of adverse events (AEs) was comparable between the netupitant/palonosetron (65.1%) and aprepitant/ondansetron (62.3%) groups. Most patients (95.7%) rated their AEs as mild to moderate. There were no deaths during the follow-up period. Despite the small sample size, our results are consistent with the current literature data. Conclusions . Netupitant/palonosetron is highly effective in the prevention of chemotherapy-induced nausea and vomiting. Its oral administration and single dose make it unique, distinguishing it from more complex previous-generation antiemetic therapy regimens. Modern antiemetic prophylaxis can improve the quality of life of most patients; however, further study of the problem of chemotherapy-induced nausea and vomiting is needed.