Addressing the value of novel therapies in chemotherapy-induced nausea and vomiting

Abstract

Chemotherapy-induced nausea and vomiting (CINV) is a troubling side effect of cancer treatment and is often poorly controlled. As a consequence, CINV is associated with substantially increased costs of care and significant interference with patients’ lives. Inadequate control over CINV results from factors that include failure to provide guideline-adherent prophylactic medication and limitations in available therapies. Newer serotonin receptor antagonists, such as palonosetron, and addition of neurokinin-1 (NK-1) receptor antagonists to treatment have significantly decreased both acute and delayed CINV. A fixed-dose combination of palonosetron and a new NK-1 receptor, netupitant, is significantly superior to palonosetron alone and has small, but consistent, numerical advantages over aprepitant plus palonosetron for prevention of CINV. The combination of a serotonin receptor antagonist plus an NK-1 receptor antagonist has been shown to be cost-effective for prevention of CINV and the availability of a fixed-dose combination of netupitant and palonosetron may enhance this benefit.

Keywords::

• aprepitant
• chemotherapy
• nausea
• netupitant
• palonosetron
• quality of life
• vomiting

Acknowledgements

The author would like to thank R Rhoades, a consultant to MedVal Scientific Information Services, LLC, for providing medical writing and editorial assistance. This manuscript was prepared according to the International Society for Medical Publication Professionals’ ‘Good Publication Practice for Communicating Company-Sponsored Medical Research: The GPP2 Guidelines’.

Financial & competing interests disclosure

Funding to support the preparation of this manuscript was provided by Eisai Inc. L Schwartzberg is a consultant/advisor for and has received funding from Eisai Inc. and Helsinn. The author has no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Key issues

• Chemotherapy-induced nausea and vomiting (CINV) remains one of the most distressing symptoms associated with cancer therapy and patients consider CINV the most troubling side effect of such treatment.

• Despite the availability of a large number of options for prophylaxis against CINV, complete protection against and control over CINV is not achieved in many patients. This may result from failure to provide guideline adherent medication, poor adherence by patients and limitations in available drugs.

• Poorly controlled CINV is associated with substantially increased cost for patient management and significant interference with patients’ lives.

• Certain serotonin receptor antagonists, such as palonosetron, and the combination of these agents with neurokinin-1 (NK-1) receptor antagonists have significantly decreased the incidences of both acute and delayed CINV.

• A fixed-dose combination of palonosetron and a new NK-1 receptor, netupitant has been demonstrated to be significantly superior to palonosetron and to have small, but consistent, numerical advantages over aprepitant plus palonosetron.

• The combination of a serotonin receptor antagonist plus an NK-1 receptor antagonist has been shown to be cost-effective for prevention of CINV and the availability of a fixed-dose combination of netupitant and palonosetron may enhance this benefit.

Notes