Additional Abstracts from the NCCN 21st Annual Conference: Advancing the Standard of Cancer Care™
Authors: Lee Schwartzberg, Eric Roeland, Paul Hesketh, Marco Palmas, Elio Carreras, Diana Tuaño, Gaudencio Vega, Jose Resubal, Zeng Wang, ; Ling, Hai-Ying Ding, Bin Cheng, Guo-Nong Yang, Ping Huang, William Carraher-Stross, Ajaykumar Patel, Jacob Habboush, Megan Single, Laeticia Hollant, Katherine Gaines, Bridget Smart, Heather Biers, Atiya Day, Robert Miller, Laura Vallow, Jennifer Peterson, Maxine Fisher, Sonia Pulgar, Matthew Kulke, Susan Pitman Lowenthal, David Cox, Paul Miller, Mark Walker, Shiv Rajan, Sanjeev Misra, Vijay Kumar, Sameer Gupta, Naseem Akhtar, Ravi Kant, Ram Jeevan, Prashant Dontula, Sumati Rao, Cynthia Macahilig, Pete Wolthoff, Qing Harshaw, Alicia Shillington
Journal: Journal of the National Comprehensive Cancer Network (2016)

Background: First-line chemotherapy for head and neck (H&N) cancers generally includes cisplatinbased regimens.Despite cisplatin's high emetogenic potential, chemotherapy-induced nausea and vomiting (CINV) can be prevented in most patients with appropriate antiemetic regimens.Antiemetic guidelines recommend that patients treated with cisplatin should receive a combination of an NK 1 receptor antagonist (NK 1 RA), 5-HT 3 RA, and dexamethasone (DEX).Adherence to antiemetic guidelines is unacceptably low, with patients frequently not receiving recommended antiemetic combinations.NEPA, which is composed of the highly selective NK 1 RA netupitant (300 mg) and the 5-HT 3 RA palonosetron (PALO; 0.50 mg), is the first oral medication targeting 2 CINV pathways in a single fixed dose in patients receiving emetogenic chemotherapy.NEPA + DEX has demonstrated superior prevention of CINV compared with oral PALO + DEX.This retrospective analysis evaluated the efficacy of NEPA in a subset of H&N patients with cancer receiving cisplatin from a pivotal trial.Methods: In this randomized double-blind trial, patients received either oral NEPA or oral PALO on day 1 before a single cycle of cisplatin-based chemotherapy.3 NEPA dose groups (netupitant, 100/200/300 mg + PALO, 0.50 mg) that show similar efficacy were pooled for this subset analysis.All patients received oral DEX on days 1-4.Concurrent radiotherapy was excluded.End points were complete response (CR = no emesis and no rescue medication), no emesis, and no significant nausea (maximum <25 mm on 100 mm visual analog scale) during the acute (0-24 hours), delayed (25-120 hours), and overall (0-120 hours) phases postchemotherapy.Results: 115 patients (86% men, 14% women) with H&N cancers received either NEPA (N=91) or PALO (N=24).CR, no emesis, and no significant nausea rates for NEPA were >90% across all phases, with an absolute incremental benefit compared with PALO of 12% for CR and no emesis and 15% for no significant nausea during the overall phase (Table 1).Overall response rates for NEPA in patients with H&N were numerically higher than those seen in patients with non-H&N cancers (N=316; CR, 87%, no emesis, 88%, no significant nausea, 84%).Conclusions: NEPA, the first oral antiemetic combination targeting 2 critical emesis pathways in a single dose, was more effective than PALO in preventing CINV in patients with H&N cancer receiving cisplatin-based highly emetogenic chemotherapy.Administered as a single oral capsule before chemotherapy, NEPA may offer a convenient and highly effective option for CINV guideline adherent treatment.AB2016-23: Table 1.NEPA for CINV in Head and Neck Cancer Complete Response (%) No Emesis (%) No Significant Nausea (%) Time Interval NEPA + DEX Oral PALO + DEX NEPA + DEX