A Meta-Analysis on the Efficacy a Fixed-Dose Combination of Netupitant and Palonosetron (NEPA) Versus Palonosetron (PALO) Alone for the Prevention of Chemotherapy-Induced Nausea and Vomiting (CINV) in Cancer Patients Receiving Emetogenic Chemotherapy
Background: Nausea and vomiting are among the most common adverse effects of emotegenic chemotherapy and, if not prevented or controlled, may lead to deleterious effects to patients, noncompliance to treatment and poor quality of life. Hence, new drugs are currently being studied to give the most favorable response for cancer patients receiving emetogenic chemotherapeutic drugs. NEPA, a combination drug of Netupitant (NETU) and Palonosetron (PALO), is the first combination oral agent that targets two distinct signaling pathways associated with chemotherapy-induced nausea and vomiting (CINV). Recent studies have suggested superiority of NEPA over the standard of care in CINV prevention.
Objective: To determine efficacy of NEPA versus PALO alone in the prevention of CINV in cancer patients given moderately to highly emetogenic chemotherapy.
Methods: All studies included in this meta-analysis were blinded randomized controlled trials (RCTs).PUBMED, Cochrane Library, Clinical Trials, and Google search engine were used in searching for related RCTs evaluating the efficacy and safety outcomes of NEPA versus PALO in the prevention of CINV in cancer patients. Review Manager 5.3 was used to analyze the data.
Results: The pooled risk ratio of the three RCTs analyzed favors NEPA over PALO in preventing CINV when using moderately to highly emetogenic chemotherapeutic agent during the overall phase of treatment. Furthermore, the sensitivity analysis of 2 RCTs which subdivided the overall phase into acute and delayed phases showed that NEPA is superior over PALO particularly during the delayed phase in preventing CINV.
Conclusion: This analysis concludes that NEPA is superior over PALO alone in preventing CINV among chemotherapy-naïve adult cancer patients receiving moderately to highly emetogenic chemotherapy during the delayed and overall phases. Even though the results are consistent with guideline recommendations, because of the moderate to high heterogeneity among the included studies, it is further proposed to include more studies to improve the power and precision of results.