Combination of netupitant and palonosetron for the prevention of nausea and vomiting induced by AC (doxorubicin + cyclophosphamide) chemotherapy in patients with breast cancer

significant decrease in the quality of life of patients, nutritional insufficiency, breaking of the chemotherapy therapy regimen. Nausea and vomiting worsen the result of chemotherapy and the prognosis of the disease. The oral combination of netupitant and palonosetron is a modern drug for the prevention of nausea and vomiting induced by chemotherapy. This combination includes a highly selective anatagonist of NK1-receptors netupitant at a dose of 300 mg and an antagonist of 5-HT3 receptors palonosetron at a dose of 0.5 mg.

Aim. To evaluate the antiemetic therapy regimen netupitant/palonosetron (NEPA, Akynzeo) + dexamethasone in breast cancer patients receiving AC chemotherapy (doxorubicin + cyclophosphamide) in real clinical practice.

Materials and methods. We conducted a single-center observational study. Patients with breast cancer receiving highly emetogenic chemotherapy (HEC) 4 cycles AC (doxorubicin 60 mg/m2 IV on the 1st day + cyclophosphamide 600 mg/ m2 IV on the 1st day once every 3 weeks or 2 weeks) as adjuvant or neoadjuvant therapy were included. All patients received netupitant/ palonosetron (NEPA, Akinzeo) + dexamethasone therapy. We evaluated complete response, absence of vomiting, absence of nausea, absence of significant nausea, and no use of rescue medication within 0-120 hours after chemotherapy after 1–4 treatment cycles. CINV was assessed using MASCC Antiemesis Tool. 52 patients were included.

Results. in the first cycle of therapy, a complete response (no vomiting and no use of rescue medication) was achieved in 100% of patients in the acute phase (0–24 hours), in 88.5% of patients in the delayed phase (24–120 hours), and in 88.5% of patients in the overall phase of therapy (0–120 hours). No patient developed vomiting during the 4 cycles. During  the  4  cycles, more  than  80%  of  patients  did  not  experience  nausea. Rescue  medication  was  required in 9.6% of patients during the 1st cycle, 11.5% of patients during the 2nd cycle, 15.3% of patients during the 3rd cycle, and 15.3% of patients during the 4th cycle. Constipation occurred in 7.7% of patients who received netupitant/palonosetron (NEPA, Akynzeo).

Conclusion. The combination of netupitant/palonosetron (NEPA, Akynzeo) for the prevention of CINV in patients with breast cancer receiving AC chemotherapy is effective and has a good safety profile in real-world clinical practice.

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