Adequate antiemetic treatment in patients receiving antitumor drug therapy

Despite the widespread use of immuno-oncological and targeted therapy in the treatment of malignant tumors, in real clinical practice the role of chemotherapy is still significant, used both in mono regimen and in combination with other antitumor drugs. Cytostatics cause a wide range of adverse events, which are often the cause of dose reduction, cyclical disorders, or even discontinuation of therapy. One of the most common symptoms is chemotherapy-induced nausea and vomiting which affect not only the quality of life, but also the results of treatment. It is important to address these issues from prevention and treatment perspectives so that patients remain committed to their treatment regimens. Since nausea and vomiting induced by chemotherapy are classified into 5 different types, the main medications for prevention and treatment include 5-hydroxytryptamine type 3 (5-HT3) and neurokinin-1 (NK1) receptor antagonists and corticosteroids. Simultaneous use of drugs from the groups of second-generation NK1 receptor blockers and 5-HT3 receptor blockers, for example: netupitant + palonosetron in combination with corticosteroids, makes it possible to achieve maximum antiemetic effect, even with the most emetogenic antitumor treatment regimens.

1. Brunton L., Hilal-Dandan R., Knollman B. Goodman & Gilman’s: The Pharmacological Basis of Therapeutics. McGraw-Hill Education, 2018.

2. Adel N. Overview of chemotherapy-induced nausea and vomiting and evidence-based therapies. Am J Manag Care 2017;23(14 Suppl): S259–65.

3. RUSSCO. Practice guidelines for the prevention and treatment of nausea and vomiting in cancer patients. 2023. (In Russ.).

4. Hesketh P.J. New treatment options for chemotherapy-induced nausea and vomiting. Support Care Cancer 2004;12(8):550–4. DOI: 10.1007/s00520-004-0651-0

5. Janelsins M.C., Tejani M.A., Kamen C. et al. Current pharmacotherapy for chemotherapy-induced nausea and vomiting in cancer patients. Expert Opin Pharmacother 2013;14(6):757–66. DOI: 10.1517/14656566.2013.776541

6. Hesketh P.J. Potential role of the NK1 receptor antagonists in chemotherapy-induced nausea and vomiting. Support Care Cancer 2001;9(5):350–4. DOI: 10.1007/s005200000199

7. Rizzi A., Campi B., Camarda V. et al. In vitro and in vivo pharmacological characterization of the novel NK1 receptor selective antagonist Netupitant. Peptides 2012;37(1):86–97. DOI: 10.1016/j.peptides.2012.06.010

8. Frame D.G. Best practice management of CINV in oncology patients: I. Physiology and treatment of CINV. Multiple neurotransmitters and receptors and the need for combination therapeutic approaches. J Support Oncol 2010;8(2 Suppl 1):5–9.

9. Rojas C., Slusher B.S. Pharmacological mechanisms of 5-HT₃ and tachykinin NK₁ receptor antagonism to prevent chemotherapyinduced nausea and vomiting. Eur J Pharmacol 2012;684(1–3):1–7. DOI: 10.1016/j.ejphar.2012.01.046

10. Wong E.H.F., Clark R., Leung E. et al. The interaction of RS 25259-197, a potent and selective antagonist, with 5-HT receptors, in vitro. Br J Pharmacol 1995;114(4):851–9. DOI: 10.1111/j.1476-5381.1995.tb13282.x

11. Rojas C., Thomas A.G., Alt J. et al. Palonosetron triggers 5-HT(3) receptor internalization and causes prolonged inhibition of receptor function. Eur J Pharmacol 2010;626(2–3):193–9. DOI: 10.1016/j.ejphar.2009.10.002

12. Rojas C., Li Y., Zhang J. et al. The antiemetic 5-HT receptor antagonist Palonosetron inhibits substance P-mediated responses in vitro and in vivo. J Pharmacol Exp Ther 2010;335(2):362–8. DOI: 10.1124/jpet.110.166181

13. Shirley M. Netupitant/palonosetron: a review in chemotherapyinduced nausea and vomiting. Drugs 2021;81(11):1331–42. DOI: 10.1007/s40265-021-01558-2

14. Hesketh P.J., Rossi G., Rizzi G. et al. Efficacy and safety of NEPA, an oral combination of netupitant and palonosetron, for prevention of chemotherapy-induced nausea and vomiting following highly emetogenic chemotherapy: a randomized dose-ranging pivotal study. Ann Oncol 2014;25(7):1340–6. DOI: 10.1093/annonc/mdu110

15. Aapro M., Rugo H., Rossi G. et al. A randomized phase III study evaluating the efficacy and safety of NEPA, a fixed-dose combination of netupitant and palonosetron, for prevention of chemotherapy-induced nausea and vomiting following moderately emetogenic chemotherapy. Ann Oncol 2014;25(7):1328–33. DOI: 10.1093/annonc/mdu101

16. Zelek L., Navari R., Aapro M., Scotté F. Single-dose NEPA versus an aprepitant regimen for prevention of chemotherapy-induced nausea and vomiting in patients receiving moderately emetogenic chemotherapy. Cancer Med 2023;12:15769–76. DOI: 10.1002/cam4.6121