Receiving a cancer diagnosis is emotional and overwhelming for patients. While initially patients may appropriately focus on understanding their disease and what their treatment options are, supportive care should begin at diagnosis and is a vital part of care across the continuum of the cancer experience. Symptom management, as a part of supportive care, is aimed at preventing the side effects of the cancer and its treatment. Appropriately managing these side effects will help enable patients to maintain their quality of life through their cancer journey.
It is well-known that, unfortunately, many cancer treatments (mainly chemotherapy) will cause nausea and vomiting. Fortunately, decades of research have improved our understanding of chemotherapy-induced nausea and vomiting (CINV) and have led to the development of very effective and safe drugs to prevent and manage these bothersome and potentially debilitating side effects. Research has also shown us that often combinations of two or three drugs taken together, sometimes over multiple days, offers the best CINV prevention with certain chemotherapies. With the appropriate use of these “antiemetic” drugs, CINV can now be prevented in the majority of patients. However, 20-30% of patients may still suffer from these side effects. Some of these patients are refractory in that the recommended antiemetic prophylactic treatments, for whatever reason, do not prevent the nausea and/or vomiting. Other patients, unfortunately, are incorrectly managed and are not given the appropriate preventative treatments. This is indefensible and not representative of an optimal patient-centered approach to cancer management. Physicians should be approaching symptom management in the same manner as they approach cancer therapeutics, utilizing the best and most appropriate treatments available.
With the goal of making prevention of CINV simpler and more convenient, the first antiemetic combination product has recently been developed, combining two drugs in a single pill that only needs to be taken right before chemotherapy is administered along with a single dose of dexamethasone. This new product (called NEPA or Akynzeo®) was recently approved by the US Food and Drug Administration (and is under review in Europe) after years of development. The combination not only comprises two drugs from two classes, an NK1 receptor antagonist (RA) and a 5-HT3 receptor antagonist, representing the current standard-of-care. The NK1 RA (netupitant) and the 5-HT3 RA (palonosetron), however, are long-acting, and palonosetron is recommended by many guidelines committees as the preferred 5-HT3 RA.
Three of the pivotal studies conducted to establish the efficacy and safety of NEPA were recently published in Annals of Oncology. These selected articles convincingly show efficacy with the NEPA combination, superior prevention of CINV compared with that of oral palonosetron, and maintenance of efficacy when given over multiple cycles of chemotherapy known to result in nausea and vomiting.
NEPA appears to be a promising new agent with the potential to address some of the barriers interfering with physicians’ administration of recommended antiemetics. This is accomplished by conveniently packaging effective and appropriate antiemetic prophylaxis in a single, oral dose that is taken only once per chemotherapy cycle, along with a single dose of dexamethasone.
Hopefully this will help, because preventing the symptoms has to be as important as treating the disease.
Heading image: Cancer cells by Dr. Cecil Fox (Photographer) for the National Cancer Institute. Public domain via Wikimedia Commons.
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