Background and importance Chemotherapy regimens with carboplatin AUC ≥4 should receive an antiemetic prophylaxis based on a triple combination of drugs. In our hospital this prophylaxis is netupitant with palonosetron (NEPA (300/0.5 mg); Akinzeo) and dexamethasone. NEPA is administered 1 hour before the chemotherapy session, so patients must take it at home before coming to hospital, with the difficulties of adherence that this implies. We evaluated shortening NEPA administration time and receiving the dose in the hospital 15 min before the chemotherapy.
Aim and objectives To evaluate the effectiveness, in terms of no acute and delayed chemotherapy-induced nausea and vomiting (CINV), of the change in administration timing of NEPA from 1 hour to 15 min before the chemotherapy.
Material and methods Single-centre, national, open-label study conducted on 129 patients from February to May 2021. The control group (NEPA 0) included ambulatory patients having NEPA + intravenous dexamethasone 1 hour and 30 min before chemotherapy, respectively. Experimental group (NEPA 1) had NEPA + intravenous dexamethasone 15 and 30 min before chemotherapy, respectively. Patients completed the MASCC Antiemesis Tool (MAT) questionnaire 24 hours and 120 hours after the chemotherapy session, to measure acute and late CINV, respectively. Differences in the proportion of acute and delayed CINV between NEPA 0 and NEPA 1 were analysed using Chi-square test.
Results A total of 129 patients participated in the study: 82 patients received NEPA 0 and 47 patients NEPA 1 (Table 1). 66 (51.2%) were female with a mean age of 66.5 years. The most frequent diagnosis was lung cancer (n=83, 64.3%). No statistically significant differences (p value >0.05) were found in either acute or delayed CINV, so both treatments can be considered similar in terms of efficacy. 13 patients started in NEPA 0 and then moved to NEPA 1; the results of the intrapatient study showed that developing CINV is more related to personal features than to NEPA administration timing.
Conclusion and relevance The change of NEPA administration timing has showed similar effectivenessto the standard one. It has beneficial implications for patients, as it allows NEPA to be administered at onco-haematological day hospital before the chemotherapy session rather than having to be taken at home. Simplifying the antiemetic prophylaxis regimen for patients is expected to increase adherence while maintaining treatment effectiveness.
Conflict of interest No conflict of interest