Efficacy and safety of oral NEPA versus fosaprepitant combined with palonosetron for preventing highly emetogenic chemotherapy-induced nausea and vomiting in patients with nasopharyngeal carcinoma.

Abstract

e18075 Background: Oral NEPA, a fixed combination of netupitant (300 mg) and palonosetron (0.5 mg), is a highly effective antiemetic agent used in patients with cancer undergoing highly emetogenic chemotherapy (HEC). However, evidence regarding its use in patients with nasopharyngeal carcinoma (NPC) is rarely reported. Methods: A total of 312 patients with stage III-IVa NPC were enrolled between January 2020 and June 2024 at Affiliated Hospital of Guangdong Medical University. 156 patients (Oral NEPA group) received a single dose of NEPA capsules orally 1 hour before each chemotherapy cycle, while 156 patients (APR + PALO group) received once intravenous drip of FosAPR (150 mg) for 30 minutes followed by once intravenous injection of PALO (0.25 mg). In addition, patients in both groups received olanzapine (10 mg/day d1-4) and dexamethasone (12 mg/day d1 and 8 mg/day d2-4). Results: All the population characteristics parameters between the two groups were balanced, and there was no statistical difference. The complete response (CR; no emetic event or rescue medication) rates in the Oral NEPA group and APR + PALO group in the overall extended phase of three IC cycles and three CCRT cycles were 80.1% vs 69.9% ( p = 0.037), 78.2% vs 68.0% ( p = 0.041), 76.3% vs 66.0% ( p = 0.046), 75.0% vs 64.7% ( p = 0.049), 74.4% vs 63.5% ( p = 0.038), 71.8% vs 60.9% ( p = 0.042), respectively. In the extended delayed phase of three CCRT cycles, the control of nausea in the Oral NEPA group was better than that in the APR + PALO group, and the no significant nausea (NSN) rates were 73.1% vs 62.2% ( p = 0.040), 69.9% vs 59.0% ( p = 0.045), 67.9% vs 57.1% ( p = 0.047), respectively. The no nausea rates were 69.9% vs 58.3% ( p = 0.034), 70.5% vs 59.6% (p = 0.044), 67.93% vs 56.4% (p = 0.048), respectively. Toxicity was similar in both groups and was well tolerated. The incidence of adverse events associated with antiemetics were ≤15% (mostly mild or moderate events) in both groups. Constipation and headache were the most common. The incidence of constipation and headache in the Oral NEPA group and APR + PALO group were 12.8% vs 14.1% (p = 0.741), and 5.8% vs 6.4% (p = 0.814), respectively. At the end of CCRT, patients with weight loss ≥5.0% (WL 5.0 ) had a PG-SGA grade of C in the Oral NEPA group and in the APR + PALO group were 55.2% vs 52.9% (p=0.859). Conclusions: Compared with the APR + PALO regimen, oral NEPA offers a more effective, long-lasting, and safe approach to preventing chemotherapy-induced nausea and vomiting caused by cisplatin chemotherapy in patients with NPC. This treatment regimen is convenient and positively impacts nutritional status.