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Background <p>Chemotherapy-induced nausea and vomiting (CINV) is a highly distressing side effect for many cancer patients. Affecting up to 40% of those undergoing treatment, it is widely considered one of the most unpleasant aspects of cancer therapy. The netupitant–palonosetron combination, known as NEPA, offers a streamlined approach to preventing CINV with a single dose.</p> Methodology <p>This study adhered to PRISMA guidelines in conducting a comprehensive review and statistical analysis of available research. This analysis assessed the efficacy of netupitant and palonosetron (NEPA) (300&#xa0;mg + 0.5&#xa0;mg) against aprepitant-based antiemetic regimen for the prevention of chemotherapy-induced nausea and vomiting (CINV).</p> Results <p>The NEPA and aprepitant (A) groups showed comparable complete response rates (78.6% and 72%, respectively), with a relative risk of 1.06 (95% confidence interval: 1.00–1.11; <i>p</i> = 0.04). The outcome of “no significant nausea” was similar in both NEPA group and A group (78.7 vs. 71%); RR = 1.07, 95 percent CI 1.02–1.13; <i>p</i> = 0.009 with no heterogeneity; <i>I</i><sup>2</sup> = 0%, <i>p</i> = 0.82. The outcome of no emesis was similar in both NEPA group and A group (77.1 vs. 74.5%); RR = 1.04, 95 percent CI 0.98–1.10; <i>p</i> = 0.23. There was no publication bias and heterogeneity observed for this outcome. Analysis revealed that the predetermined thresholds for trial sequential monitoring were not surpassed, suggesting that the current sample size is insufficient to draw definitive conclusions about the intervention’s efficacy, and additional studies with larger sample sizes are needed.</p> Conclusion <p>NEPA showed comparable efficacy to aprepitant-based regimens in a meta-analysis, despite individual studies suggesting superiority. NEPA’s single-dose administration offers convenience and may improve adherence, contrasting with the multi-day regimen of aprepitant. Combining NEPA with dexamethasone aligns with standard practice. Future research, including cost-effectiveness analyses, could better assess NEPA’s overall value compared to traditional therapies.</p>

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Efficacy of Netupitant–Palonosetron Combination Therapy Compared to Aprepitant-Based Regimens for Chemotherapy-Induced Nausea and Vomiting: A Systematic Review, Meta-Analysis, and Trial Sequential Analysis

  • 期刊论文

  • 发表日期：

    2025年4月13日

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  • Madhusudan Prasad Singh,
  • Meenalotchini Prakash Gurunthalingam,
  • Vikas Katiyara,
  • Siddharth Kambley

摘要

Background

Chemotherapy-induced nausea and vomiting (CINV) is a highly distressing side effect for many cancer patients. Affecting up to 40% of those undergoing treatment, it is widely considered one of the most unpleasant aspects of cancer therapy. The netupitant–palonosetron combination, known as NEPA, offers a streamlined approach to preventing CINV with a single dose.

Methodology

This study adhered to PRISMA guidelines in conducting a comprehensive review and statistical analysis of available research. This analysis assessed the efficacy of netupitant and palonosetron (NEPA) (300 mg + 0.5 mg) against aprepitant-based antiemetic regimen for the prevention of chemotherapy-induced nausea and vomiting (CINV).

Results

The NEPA and aprepitant (A) groups showed comparable complete response rates (78.6% and 72%, respectively), with a relative risk of 1.06 (95% confidence interval: 1.00–1.11; p = 0.04). The outcome of “no significant nausea” was similar in both NEPA group and A group (78.7 vs. 71%); RR = 1.07, 95 percent CI 1.02–1.13; p = 0.009 with no heterogeneity; I2 = 0%, p = 0.82. The outcome of no emesis was similar in both NEPA group and A group (77.1 vs. 74.5%); RR = 1.04, 95 percent CI 0.98–1.10; p = 0.23. There was no publication bias and heterogeneity observed for this outcome. Analysis revealed that the predetermined thresholds for trial sequential monitoring were not surpassed, suggesting that the current sample size is insufficient to draw definitive conclusions about the intervention’s efficacy, and additional studies with larger sample sizes are needed.

Conclusion

NEPA showed comparable efficacy to aprepitant-based regimens in a meta-analysis, despite individual studies suggesting superiority. NEPA’s single-dose administration offers convenience and may improve adherence, contrasting with the multi-day regimen of aprepitant. Combining NEPA with dexamethasone aligns with standard practice. Future research, including cost-effectiveness analyses, could better assess NEPA’s overall value compared to traditional therapies.