The role of NEPA, a combination of netupitant and palonosetron, in the prevention of nausea and vomiting: case report and literature review

Abstract

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.