NEPA (netupitant/palonosetron) consists of the combination of the 5-HT3 receptor antagonist palenosetron and the NK1 receptor antagonist netupitant. An advantage of the drug is that it is a single oral medication working on two mechanisms, stated Eric Roeland, MD. Netupitant has a 96-hour half-life, and palonosetron has a 3-day half-life. The FDA approval for NEPA is for nausea and vomiting prevention in patients receiving highly emetogenic chemotherapy, but it is not limited to use in that setting, he adds.
Three recent clinical trials were published regarding the combination agent, according to Charles L. Loprinzi, MD. One was a five-arm study. Three of the arms were palenosetron plus netupitant at 100 mg, 200 mg, and 300 mg, respectively, the fourth arm was palonosetron monotherapy, and the fifth arm included ondansetron plus aprepitant. The results showed superiority with the combination of netupitant at the 300-mg dose and palenosetron, he says.
A second study examined the NEPA combination given at different cycles and compared them to the combination of aprepitant and palonosetron. About 75% of patients received highly emetogenic chemotherapy, and about 25% received moderately emetogenic chemotherapy, explained Loprinzi. The results showed that the two regimens were similar.
The third trial was among patients who were receiving moderately emetogenic chemotherapy. It compared netupitant plus palonosetron to palonosetron alone, and this demonstrated that the combination was better at controlling nausea and vomiting than palonosetron alone, he adds.