medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/ms2023-217medsovet-7694Research ArticleПОДДЕРЖИВАЮЩАЯ ТЕРАПИЯSUPPORTIVE THERAPYРоль комбинации палоносетрона и нетупитанта (NEPA) в профилактике тошноты и рвоты: обзор литературы и клинический случайThe role of NEPA, a combination of netupitant and palonosetron, in the prevention of nausea and vomiting: case report and literature reviewhttps://orcid.org/0000-0003-4443-9974РумянцевА. А.RumyantsevA. A.

Румянцев Алексей Александрович, к.м.н., старший научный сотрудник онкологического отделения лекарственных методов лечения (химиотерапевтическое) №4 отдела лекарственного лечения Научного исследовательского института клинической онкологии имени академика РАН и РАМН Н.Н. Трапезникова 

115478, Россия, Москва, Каширское шоссе, д. 24 

Alexey А. Rumyantsev, Cand. Sci. (Med.), Senior Researcher, Cancer Drug Therapy (Chemotherapeutic) Department No. 4, MedicationBased Treatment Unit, N.N. Trapeznikov Research Institute of Clinical Oncology

24, Kashirskoye Shosse, Moscow, 115478, Russia 

alexeymma@gmail.comРябишинаО. Е.RyabishinaO. E.

Рябишина Оксана Евгеньевна, врач-онколог, аспирант онкологического отделения лекарственных методов лечения (химиотерапевтическое) №4 отдела лекарственного лечения Научного исследовательского института клинической онкологии имени академика РАН и РАМН Н.Н. Трапезникова 

115478, Россия, Москва, Каширское шоссе, д. 24 

Oxana E. Ryabishina, Oncologist, Graduate Student, Cancer Drug Therapy (Chemotherapeutic) Department No. 4, Medication-Based Treatment Unit, N.N. Trapeznikov Research Institute of Clinical Oncology

24, Kashirskoye Shosse, Moscow, 115478, Russia 

oksanaryabishina@gmail.comНациональный медицинский исследовательский центр онкологии имени Н.Н. БлохинаРоссияBlokhin National Medical Research Center of OncologyRussian Federation202328072023011100107Copyright © Румянцев А.А., Рябишина О.Е., 20232023Румянцев А.А., Рябишина О.Е.Rumyantsev A.A., Ryabishina O.E.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/7694

Тошнота и рвота (ТиР) на фоне химиотерапии – одно из наиболее часто встречающихся осложнений лечения злокачественных новообразований. Проявления этого осложнения во многом определяются субъективными ощущениями и индивидуальными особенностями пациентов, но не вызывает сомнений, что развитие этого осложнения оказывает значимое негативное влияние на качество жизни онкологических пациентов. Последние декады ознаменовались значительными достижениями в области профилактики ТиР, в клиническую практику вошло множество эффективных противорвотных препаратов. Действующие клинические рекомендации по проведению противорвотной терапии предусматривают различные возможные стратегии профилактики ТиР, но не приводят каких-либо конкретных указаний по выбору индивидуальных агентов для профилактики ТиР в рамках каждого класса эметогенности. Наиболее современными представителями препаратов класса NK1- и 5-HT3-антагонистов являются нетупитант и палоносетрон, объединенные в фиксированную комбинацию NEPA. Данная статья посвящена обзору современных данных по эффективности применения этого препарата и поискам его ниши в противорвотной терапии. Освещены результаты исторических и наиболее актуальных исследований, демонстрирующих эффективность данной комбинации в профилактике ТиР, фармакологические особенности и потенциальные преимущества нетупитанта и палоносетрона перед другими препаратами соответствующих классов. На примере клинического случая лечения пациентки с отягощенным анамнезом (сахарного диабета 2-го типа с плохо контролируемой гипергликемией) оценена роль препарата в существующем терапевтическом арсенале. Достигнут полный ответ на противорвотную терапию – у пациентки не было зарегистрировано эпизодов рвоты на фоне лечения, максимальная выраженность тошноты – в рамках 1-й степени, дополнительного назначения противорвотных препаратов не требовалось.

Chemotherapy-induced nausea and vomiting (CINV) is one of the most common complications of the systemic anticancer treatment. The manifestations of this complication are largely determined by subjective perceptions and individual characteristics of patients, but this complication may have unprecedented negative impact on the quality of life of cancer patients. There were significant advances in CINV prophylaxis in the recent decades, with many effective antiemetic drugs entering routine clinical practice. Current clinical guidelines for antiemetic therapy provide various possible strategies for CINV prevention, but do not give any specific guidance on the selection of individual agents within each class of emetogenic potential. NEPA, which is a fixed-dose combination of NK1-antagonist netupitant and 5-HT3 antagonist palonosteron, is the most recent antiemetic drug in clinical practice. This article reviews current data on the effectiveness of this drug and aims to define its “niche” in antiemetic therapy. The results of historical and most relevant studies demonstrating the effectiveness of NEPA in CINV prevention, pharmacological features of the drug and its potential advantages are discussed. The role of the drug in the existing therapeutic arsenal was evaluated using the example of a clinical report of treatment of a patient with an aggravated history (type 2 diabetes mellitus with poorly controlled hyperglycaemia) The patient achieved a complete response to the antiemetic therapy: no episodes of vomiting during treatment, the severity of nausea did not exceed the 1st grade, no additional prescription of antiemetic drugs was required.

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The authors declare that there are no conflicts of interest present.