Impact of Antiemetic Prophylaxis on Quality of Life of Patients Treated with Chemotherapy – Data from Practice
Chemotherapy-induced nausea and vomiting (CINV) is a relatively common complication of cancer treatment with a significantly negative impact on patients' quality of life. A large prospective analysis of real-world clinical practice data was conducted in Germany, examining the efficacy and safety of treatment with the oral combination of netupitant and palonosetron and the impact of this therapy on patients' quality of life.
Managing Side Effects of Chemotherapy with Emetogenic Potential
According to the recommendations of professional societies, prophylaxis with a triple combination of neurokinin 1 (NK1) receptor antagonists, 5-hydroxytryptamine 3 (5-HT3) receptor antagonists, and dexamethasone is advised for patients treated with chemotherapy with high emetogenic potential (e.g., regimens based on anthracyclines/cyclophosphamide).
Despite professional recommendations, low adherence to the recommended therapy is often observed in real-world practice among prescribing physicians and patients themselves. One factor may be the relatively complex dosing schedule of antiemetic prophylaxis. The only available oral fixed combination of antiemetics is NEPA: 300 mg of netupitant (an NK1 antagonist) with 0.5 mg of palonosetron (a 5-HT3 antagonist). Using NEPA in combination with dexamethasone allows for the administration of antiemetic prophylaxis with a minimal number of doses and reduced risk of patient administration errors.
Phase II and III clinical studies have demonstrated the safety and efficacy of this treatment under controlled clinical trial conditions. A group of German oncologists conducted a non-interventional study in real-world clinical practice conditions, focusing especially on assessing the quality of life of patients receiving antiemetic prophylaxis.
Study Methodology
The prospective non-interventional study was conducted from September 2015 to March 2018 in 162 German centers. The evaluation involved 2,429 adult patients with solid or hematological tumors treated with 1- or 2-day regimens with moderate (MEC) or high emetogenic potential (HEC). Patients were administered the NEPA combination in accordance with the SPC (one dose of NEPA with 12 mg of dexamethasone approximately 1 hour before the start of the chemotherapy cycle; in patients treated with non-anthracycline HEC, 8 mg of dexamethasone was additionally administered once daily on days 2−4).
The main goal of the study was to assess the quality of life of the patients, while secondary goals included assessing efficacy and safety profile.
Results
Data could be analyzed for 2,173 participating patients, with an overall complete response rate of 83%. Complete response for acute vomiting was achieved by 89% of patients, and for delayed vomiting by 87%.
85% of HEC-treated patients reported no impact of vomiting on their daily life during the first chemotherapy cycle. In the group of MEC-treated patients, this figure was 82%. Nausea did not affect the daily life of 54% of HEC-treated and 59% of MEC-treated patients during the first cycle of treatment. NEPA administration was well tolerated.
Conclusion
In real-world clinical practice conditions, antiemetic prophylaxis with the fixed combination NEPA was effective and safe and had a positive impact on the quality of life of a heterogeneous group of cancer patients.
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Source: Karthaus M., Oskay-Özcelik G., Wülfing P. et al. Real-world evidence of NEPA, netupitant-palonosetron, in chemotherapy-induced nausea and vomiting prevention: effects on quality of life. Future Oncol 2020; 16 (14): 939−953, doi: 10.2217/fon-2020-0187.
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