Real hopes in antiemetic therapy

Abstract

Anticancer drug therapy has made significant progress in the last two decades. However, the correction of adverse events and complications that arise during treatment requires special attention. Most often, special antitumor therapy can cause side effects from the gastrointestinal tract. Chemo-induced nausea and vomiting is the most common adverse event associated with drug therapy of cancer. It significantly worsens the well-being and quality of life of patients. With multiple cycles of chemotherapy, episodes of both acute and delayed nausea/vomiting may occur. There are several pharmacological groups of antiemetics. The most effective regimen for the prevention of chemotherapy-induced nausea and vomiting is a combination of serotonin receptor (5-HT3) and neurokinin receptor (NK-1) antagonists. It provides high symptom control in both the acute and delayed phases of nausea/vomiting. Palonosetron, a new-generation serotonin receptor antagonist, differs from firstgeneration 5-HT3 receptor antagonists in its stronger and longer-lasting antiemetic effect with a comparable safety profile. Oral administration of palonosetron is not inferior in effectiveness to its intravenous administration. An oral combination drug containing the NK-1 antagonist netupitant and the 5-HT3 antagonist palonosetron is highly effective in preventing nausea and vomiting in moderately and highly emetogenic drug regimens. The long half-life of both drugs and their high affinity to their receptors provide a long-lasting and persistent effect even with a single dose. This combination is particularly effective in relieving symptoms of delayed nausea/vomiting. A number of clinical studies have demonstrated that a single oral dose of netupitant/palonosetron combination is significantly more effective than 3-day aprepitant-based regimens in preventing delayed chemotherapy-induced nausea and vomiting. In addition, the netupitant/palonosetron combination may be cost-effective by reducing the cost of managing of complications of poorly controlled nausea and vomiting.