帕洛诺司琼止吐的效果怎么样?

NEPA is the only fixed-combination antiemetic agent, consisting of NK1 RA (netupitant) and 5-HT3 RA (palonosetron). In the first head-to-head trial comparing NK1 RA-containing regimens, a single oral dose of NEPA was noninferior to a 3-day aprepitant/granisetron (APR/GRAN) regimen on the primary endpoint of overall (0-120 hours) complete response (no vomiting/no resuscitation).

This prespecified analysis evaluated the efficacy of NEPA versus APR/GRAN in a subset of Chinese patients. In addition, the efficacy of high-dose cisplatin (≥70 mg/m2) in patients most at risk for emesis was explored.

In this randomized, double-blind study, patients with chemotherapy-naïve solid tumors received a single dose of NEPA before cisplatin-based chemotherapy or a 3-day APR/GRAN regimen on days 1-4 along with dexamethasone. Efficacy was assessed by rates of complete remission, absence of vomiting and absence of significant nausea in the acute phase (0-24 hours), delayed phase (25-120 hours) and overall post-chemotherapy phase, as well as on individual days, as daily courses of CINV (antiemetic) protection have generally not been studied.

The Chinese subcohort included 667 patients; 363 (54%) received high-dose cisplatin. Baseline characteristics were comparable. Although the response rates of NEPA and APR/GRAN were similar in the acute, delayed, and overall phases, significantly fewer NEPA patients developed breakthrough CINV on days 3-5 among Chinese patients and those receiving high cisplatin.

As a fixed oral NK1 RA/5HT3 RA combination administered once per cycle, NEPA (netupitant/palonosetron

) is a convenient, highly effective prophylactic antiemetic that provides better CINV protection than the 3-day APR/GRAN regimen on days 3-5 after highly emetogenic chemotherapy.

It is a selective antagonist of 5-hydroxytryptamine 3 receptors with very strong affinity. Chemotherapy drugs mainly stimulate the release of 5-hydroxytryptamine from intestinal chromaffin cells, and 5-hydroxytryptamine reactivates the 5-hydroxytryptamine 3 receptors of the vagal afferent nerve, thereby producing a vomiting response. Palonosetron acts on this pathway, thereby exerting an antiemetic effect. It is recommended that patients take medication under the guidance of a doctor and receive symptomatic treatment.

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References

Chang J, Chen G, Wang D, Wang G, Lu S, Feng J, Li W, Li P, Lanzarotti C, Chessari S, Zhang L. Efficacy of NEPA, a fixed antiemetic combination of netupitant and palonosetron, vs a 3-day aprepitant regimen for prevention of chemotherapy-induced nausea and vomiting (CINV) in Chinese patients receiving highly emetogenic chemotherapy (HEC) in a randomized Phase 3 study. Cancer Med. 2020 Jul;9(14):5134-5142. doi: 10.1002/cam4.3123. Epub 2020 May 30. PMID: 32472742; PMCID: PMC7367622.