A phase III study evaluating the safety and efficacy of NEPA, a fixed-dose combination of netupitant and palonosetron, for prevention of chemotherapy-induced nausea and vomiting over repeated cycles of chemotherapy

被引:139
作者
Gralla, R. J. [1 ]
Bosnjak, S. M. [2 ]
Hontsa, A. [3 ]
Balser, C. [4 ]
Rizzi, G. [5 ]
Rossi, G. [6 ]
Borroni, M. E. [6 ]
Jordan, K. [7 ]
机构
[1] Albert Einstein Coll Med, Jacobi Med Ctr, Dept Med Oncol, Bronx, NY 10461 USA
[2] Inst Oncol & Radiol Serbia, Dept Support Oncol, Belgrade, Serbia
[3] Chernivtsi Reg Canc Hosp, Chernovtsy, Ukraine
[4] OnkoNet Marburg GmbH, Marburg, Germany
[5] Helsinn Healthcare SA, Dept Stat & Data Management, Lugano, Switzerland
[6] Helsinn Healthcare SA, Dept Corp Clin Dev, Lugano, Switzerland
[7] Univ Halle Wittenberg, Dept Hematol & Oncol, D-06108 Halle, Germany
关键词
neurokinin-1 receptor antagonist; NEPA; netupitant; palonosetron; CINV; multiple chemotherapy cycles;
D O I
10.1093/annonc/mdu096
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Safe, effective and convenient antiemetic regimens that preserve benefit over repeated cycles are needed for optimal supportive care during cancer treatment. NEPA, an oral fixed-dose combination of netupitant, a highly selective NK1 receptor antagonist (RA), and palonosetron (PALO), a distinct 5-HT3 RA, was shown to be superior to PALO in preventing chemotherapy-induced nausea and vomiting after a single cycle of highly (HEC) or moderately (MEC) emetogenic chemotherapy in recent trials. This study was designed primarily to assess the safety but also to evaluate the efficacy of NEPA over multiple cycles of HEC and MEC. This multinational, double-blind, randomized phase III study (NCT01376297) in 413 chemotherapy-na < ve patients evaluated a single oral dose of NEPA (NETU 300 mg + PALO 0.50 mg) given on day 1 with oral dexamethasone (DEX). An oral 3-day aprepitant (APR) regimen + PALO + DEX was included as a control (3:1 NEPA:APR randomization). In HEC, DEX was administered on days 1-4 and in MEC on day 1. Safety was assessed primarily by adverse events (AEs), including cardiac AEs; efficacy by complete response (CR: no emesis, no rescue). Patients completed 1961 total chemotherapy cycles (76% MEC, 24% HEC) with 75% completing a parts per thousand yen4 cycles. The incidence/type of AEs was comparable for both groups. Most frequent NEPA-related AEs included constipation (3.6%) and headache (1.0%); there was no indication of increasing AEs over multiple cycles. The majority of AEs were mild/moderate and there were no cardiac safety concerns based on AEs and electrocardiograms. The overall (0-120 h) CR rates in cycle 1 were 81% and 76% for NEPA and APR + PALO, respectively, and antiemetic efficacy was maintained over repeated cycles. NEPA, a convenient single oral dose antiemetic targeting dual pathways, was safe, well tolerated and highly effective over multiple cycles of HEC/MEC.
引用
收藏
页码:1333 / 1339
页数:7
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