Safety and Efficacy of Netupitant/Palonosetron and Dexamethasone in Classical Hodgkin’s Lymphoma Patients with Inadequate Chemotherapy-Induced Nausea and Vomiting Prophylaxis with Palonosetron and Dexamethasone: A Single-Center Real-Life Experience

Abstract

We analyzed safety of NEPA (netupitant/palonosetron) and dexamethasone (NEPA+DEX) for the management of chemotherapy-induced nausea and vomiting (CINV) in classical Hodgkin’s lymphoma patients that experienced CINV with a prophylaxis with palonosetron (PALO + DEX). In a retrospective, monocentric, noncomparative study, we analyzed adverse events and CINV grading in patients who switched from PALO + DEX to NEPA + DEX. Among 32 patients treated with ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine) during the study period, 47% did not properly control CINV with PALO + DEX and were shifted to NEPA + DEX. Among these, 53.3% properly controlled CINV is for all the remaining chemotherapy cycles. We did not observe an increase of adverse events after switching to NEPA. In our study, NEPA did not show drug–drug interaction with ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine) chemotherapy agents and NEPA administration was well tolerated with mild and transient adverse events.

Netupitant-palonosetron (NEPA) for Preventing Chemotherapy-induced Nausea and Vomiting: From Clinical Trials to Daily Practice

“…Oral NEPA has also been evaluated in settings outside of the label specifications. The oral combination of NEPA and dexamethasone effectively controlled CINV in patients for whom previous treatment with 5HT 3 RA-dexamethasone prophylaxis for different chemotherapeutic regimens had failed [ 55 , 56 ]. Furthermore, oral NEPA has been explored in single- and multiple-dose regimens to prevent CINV during conditioning with multiple-day high-dose chemotherapy in preparation for HCT [ 60 - 62 ].…”

“…Oral NEPA treatment was well-tolerated, with only two patients experiencing grade 1 constipation. Another study retrospectively investigated oral NEPA-dexamethasone in patients with Hodgkin’s lymphoma who had experienced CINV with previous palonosetron-dexamethasone prophylaxis for the doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) combination [ 56 ]. For 15 out of the 32 patients (47%) treated with ABVD, palonosetron did not control CINV; therefore, these patients were shifted to oral NEPA in the following cycle.…”