title: A Review of NEPA, a Novel Fixed Antiemetic Combination with the Potential for Enhancing Guideline Adherence and Improving Control of Chemotherapy-Induced Nausea and Vomiting.
abstract: Combination antiemetic regimens targeting multiple molecular pathways associated with emesis have become the standard of care for prevention of chemotherapy-induced nausea and vomiting (CINV) related to highly and moderately emetogenic chemotherapies. Antiemetic consensus guidelines from several professional societies are widely available and updated regularly as new data emerges. Unfortunately, despite substantial research supporting the notion that guideline conformity improves CINV control, adherence to antiemetic guidelines is unsatisfactory. While studies are needed to identify specific barriers to guideline use and explore measures to enhance adherence, a novel approach has been taken to improve clinician adherence and patient compliance, with the development of a new combination antiemetic. NEPA is an oral fixed combination of a new highly selective NK1 receptor antagonist (RA), netupitant, and the pharmacologically and clinically distinct 5-HT3 RA, palonosetron. This convenient antiemetic combination offers guideline-consistent prophylaxis by targeting two critical pathways associated with CINV in a single oral dose administered only once per cycle. This paper will review and discuss the NEPA data in the context of how this first combination antiemetic may overcome some of the barriers interfering with adherence to antiemetic guidelines, enhance patient compliance, and offer a possible advance in the prevention of CINV for patients.
authors.affiliation: Lahey Hospital & Medical Center, 41 Mall Road, Burlington, MA 01805, USA.
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Hesketh
authors.affiliation: Institut Multidisciplinaire d'Oncologie, Clinique de Genolier, Case Postale 100, Route du Muids 3, 1272 Genolier, Switzerland.
authors.forename: Matti
authors.initials: M
authors.lastname: Aapro
authors.affiliation: Department of Internal Medicine IV, Hematology/Oncology, Martin-Luther-University Halle/Wittenberg, Ernst-Grube-Straße 40, 06120 Halle, Germany.
authors.forename: Karin
authors.initials: K
authors.lastname: Jordan
authors.affiliation: The West Clinic, 100 Humphreys Boulevard, Memphis, TN 38120, USA.
authors.forename: Lee
authors.initials: L
authors.lastname: Schwartzberg
authors.affiliation: Institute for Oncology and Radiology of Serbia, Pasterova 14, 11000 Belgrade, Serbia.
authors.forename: Snezana
authors.initials: S
authors.lastname: Bosnjak
authors.affiliation: University of California San Francisco Helen Diller Family Comprehensive Cancer Center, 1600 Divisadero Street, P.O. Box 1710, San Francisco, CA 94115, USA.
authors.forename: Hope
authors.initials: H
authors.lastname: Rugo
mesh_terms: D000932:Antiemetics / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000009:adverse effects*; D019983:Guideline Adherence; D006801:Humans; D007546:Isoquinolines / Q000627:therapeutic use*; D009325:Nausea / Q000139:chemically induced* / Q000188:drug therapy; D000077924:Palonosetron; D011725:Pyridines / Q000627:therapeutic use*; D011812:Quinuclidines / Q000627:therapeutic use*; D014839:Vomiting / Q000139:chemically induced* / Q000188:drug therapy; D010879:Piperazines; D044482:Benzeneacetamides
chemical_list: D000932:Antiemetics; D000970:Antineoplastic Agents; D007546:Isoquinolines; D000077924:Palonosetron; D011725:Pyridines; D011812:Quinuclidines; C508854:netupitant; D010879:Piperazines; D044482:Benzeneacetamides