Modern opportunities for the prevention of chemotherapy-induced nausea and vomiting: the role of the fixed combination netupitant + palonosetron

The article summarises current views on the pathogenesis of chemotherapy-induced nausea and vomiting (CINV) and substantiates the expediency of using combined antiemetic strategies in patients receiving moderately and highly emetogenic chemotherapy.The roles of peripheral and central mechanisms in the formation of the emetic reflex, involving serotonin 5-HT₃ and neurokinin-1 (NK 1 ) receptors, are considered, underscoring the need for a multicomponent, pathogenetically targeted approach to CINV prophylaxis.Particular attention is paid to the fixed combination of netupitant and palonosetron (NEPA) as a modern means of antiemetic prophylaxis.The pharmacological and pharmacokinetic properties of NEPA components, their synergistic interactions, and their clinical advantages, in particular, effective control of both acute and delayed phases of CINV, are analysed.Data from randomised clinical studies and meta-analyses are presented that confirm NEPA's high clinical efficacy, safety, and convenience compared with traditional aprepitant-containing regimens.The place of the fixed combination netupitant + palonosetron in current international clinical recommendations from Multinational Association of Supportive Care in Cancer / European Society for Medical Oncology (MASCC / ESMO) and American Society of Clinical Oncology (ASCO) as one of the agents of choice for CINV prophylaxis is shown, which contributes to increased patient adherence to treatment and to the optimisation of supportive therapy in oncology practice.