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Loteta B, Paviglianiti A, Naso V, Ferreri A, Moscato T, Console G, Canale FA, Irrera G, Pugliese M, Di Costanzo A, Provenzano PF, Loddo V, Porto G, Cusumano G, Russo L, Meliambro N, Romeo V, Porcino D, Gallo S, Gangemi T, Rossetti AM, Martino M. Netupitant/palonosetron without dexamethasone for preventing nausea and vomiting in patients with multiple myeloma receiving high-dose melphalan for autologous stem cell transplantation: a single-center experience. Support Care Cancer 2021; 30:585-591. [PMID: 34347181 PMCID: PMC8331991 DOI: 10.1007/s00520-021-06472-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 07/24/2021] [Indexed: 11/29/2022]
Abstract
Chemotherapy-induced nausea and vomiting (CINV) is one of the most frequent adverse events compromising quality of life (QoL) in patients undergoing autologous stem cell transplantation (ASCT). However, CINV prophylaxis is still lacking uniformity for high-dose melphalan (HDM), which is used to condition patients with multiple myeloma (MM). Netupitant/palonosetron (NEPA) is administered with dexamethasone (DEXA) for CINV prevention in several chemotherapy regimens. Our study aims to assess the efficacy of NEPA, without DEXA, in preventing CINV in 106 adult patients with MM receiving HDM and ASCT. All patients had antiemetic prophylaxis with multiple doses of NEPA 1 h before the start of conditioning and after 72 h and 120 h. A complete response (CR) was observed in 99 (93%) patients at 120 h (overall phase). The percentage of patients with complete control was 93%. The CR rate during the acute phase was 94% (n = 100). During the delayed phase, the CR rate was 95% (n = 101). Grade 1 nausea and vomiting were experienced by 82% and 12% of the patients, respectively. Grade 2 nausea was reported in 18% and vomiting in 10% of patients. Our results showed, for the first time, that NEPA, without DEXA, was a well-tolerated and effective antiemetic option for MM patients receiving HDM followed by ASCT.
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Affiliation(s)
- Barbara Loteta
- Stem Cell Transplant and Cellular Therapies Unit, Hemato-Oncology and Radiotherapy Department, Grande Ospedale Metropolitano "Bianchi-Melacrino-Morelli", Viale Europa, 89133, Reggio Calabria, Italy
| | - Annalisa Paviglianiti
- Stem Cell Transplant and Cellular Therapies Unit, Hemato-Oncology and Radiotherapy Department, Grande Ospedale Metropolitano "Bianchi-Melacrino-Morelli", Viale Europa, 89133, Reggio Calabria, Italy
| | - Virginia Naso
- Stem Cell Transplant and Cellular Therapies Unit, Hemato-Oncology and Radiotherapy Department, Grande Ospedale Metropolitano "Bianchi-Melacrino-Morelli", Viale Europa, 89133, Reggio Calabria, Italy
| | - Anna Ferreri
- Stem Cell Transplant and Cellular Therapies Unit, Hemato-Oncology and Radiotherapy Department, Grande Ospedale Metropolitano "Bianchi-Melacrino-Morelli", Viale Europa, 89133, Reggio Calabria, Italy
| | - Tiziana Moscato
- Stem Cell Transplant and Cellular Therapies Unit, Hemato-Oncology and Radiotherapy Department, Grande Ospedale Metropolitano "Bianchi-Melacrino-Morelli", Viale Europa, 89133, Reggio Calabria, Italy
| | - Giuseppe Console
- Stem Cell Transplant and Cellular Therapies Unit, Hemato-Oncology and Radiotherapy Department, Grande Ospedale Metropolitano "Bianchi-Melacrino-Morelli", Viale Europa, 89133, Reggio Calabria, Italy
| | - Filippo Antonio Canale
- Stem Cell Transplant and Cellular Therapies Unit, Hemato-Oncology and Radiotherapy Department, Grande Ospedale Metropolitano "Bianchi-Melacrino-Morelli", Viale Europa, 89133, Reggio Calabria, Italy
| | - Giuseppe Irrera
- Stem Cell Transplant and Cellular Therapies Unit, Hemato-Oncology and Radiotherapy Department, Grande Ospedale Metropolitano "Bianchi-Melacrino-Morelli", Viale Europa, 89133, Reggio Calabria, Italy
| | - Marta Pugliese
- Stem Cell Transplant and Cellular Therapies Unit, Hemato-Oncology and Radiotherapy Department, Grande Ospedale Metropolitano "Bianchi-Melacrino-Morelli", Viale Europa, 89133, Reggio Calabria, Italy
| | | | - Pasquale Fabio Provenzano
- Stem Cell Transplant and Cellular Therapies Unit, Hemato-Oncology and Radiotherapy Department, Grande Ospedale Metropolitano "Bianchi-Melacrino-Morelli", Viale Europa, 89133, Reggio Calabria, Italy
| | - Viviana Loddo
- Catholic University of the Sacred Heart, Rome, Italy
| | - Gaetana Porto
- Stem Cell Transplant and Cellular Therapies Unit, Hemato-Oncology and Radiotherapy Department, Grande Ospedale Metropolitano "Bianchi-Melacrino-Morelli", Viale Europa, 89133, Reggio Calabria, Italy
| | - Giuseppa Cusumano
- Stem Cell Transplant and Cellular Therapies Unit, Hemato-Oncology and Radiotherapy Department, Grande Ospedale Metropolitano "Bianchi-Melacrino-Morelli", Viale Europa, 89133, Reggio Calabria, Italy
| | - Letteria Russo
- Stem Cell Transplant and Cellular Therapies Unit, Hemato-Oncology and Radiotherapy Department, Grande Ospedale Metropolitano "Bianchi-Melacrino-Morelli", Viale Europa, 89133, Reggio Calabria, Italy
| | - Nicola Meliambro
- Stem Cell Transplant and Cellular Therapies Unit, Hemato-Oncology and Radiotherapy Department, Grande Ospedale Metropolitano "Bianchi-Melacrino-Morelli", Viale Europa, 89133, Reggio Calabria, Italy
| | - Valentina Romeo
- Stem Cell Transplant and Cellular Therapies Unit, Hemato-Oncology and Radiotherapy Department, Grande Ospedale Metropolitano "Bianchi-Melacrino-Morelli", Viale Europa, 89133, Reggio Calabria, Italy
| | - Domenico Porcino
- Stem Cell Transplant and Cellular Therapies Unit, Hemato-Oncology and Radiotherapy Department, Grande Ospedale Metropolitano "Bianchi-Melacrino-Morelli", Viale Europa, 89133, Reggio Calabria, Italy
| | - Salvatore Gallo
- Stem Cell Transplant and Cellular Therapies Unit, Hemato-Oncology and Radiotherapy Department, Grande Ospedale Metropolitano "Bianchi-Melacrino-Morelli", Viale Europa, 89133, Reggio Calabria, Italy
| | - Tiziana Gangemi
- Stem Cell Transplant and Cellular Therapies Unit, Hemato-Oncology and Radiotherapy Department, Grande Ospedale Metropolitano "Bianchi-Melacrino-Morelli", Viale Europa, 89133, Reggio Calabria, Italy
| | - Antonio Maria Rossetti
- Stem Cell Transplant and Cellular Therapies Unit, Hemato-Oncology and Radiotherapy Department, Grande Ospedale Metropolitano "Bianchi-Melacrino-Morelli", Viale Europa, 89133, Reggio Calabria, Italy
| | - Massimo Martino
- Stem Cell Transplant and Cellular Therapies Unit, Hemato-Oncology and Radiotherapy Department, Grande Ospedale Metropolitano "Bianchi-Melacrino-Morelli", Viale Europa, 89133, Reggio Calabria, Italy.
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Tendas A, Marchesi F, Mengarelli A, Annibali O, Tomarchio V, Saltarelli D, Chierichini A, Di Venanzio M, Sollazzo F, Piedimonte M, Cupelli L, Bruno A, De Angelis G, Delbono L, Niscola P, Perrotti AP, de Fabritiis P, Arcese W. Prevention of chemotherapy-induced nausea and vomiting after high-dose melphalan and stem cell transplantation: review of the evidence and suggestions. Support Care Cancer 2018; 27:793-803. [PMID: 30564934 DOI: 10.1007/s00520-018-4594-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 12/06/2018] [Indexed: 11/26/2022]
Abstract
INTRODUCTION High-dose melphalan (HDMel) is the most common conditioning chemotherapy regimen for autologous stem cell transplantation (SCT) in patients affected by multiple myeloma (MM). No consensus exists for the emetogenicity or prophylaxis of chemotherapy-induced nausea and vomiting (CINV) in this regimen. METHODS Data on the incidence and efficacy/safety of CINV prophylaxis among patients affected by MM undergoing autologous SCT with the HDMel regimen was extracted from electronic databases and analyzed. RESULTS Eleven studies involving multiple CINV prophylaxis regimens were identified and included. No consensus on HDMel emetogenicity was reached, but most studies summarized the emetogenicity as moderate-high risk. An aprepitant-based three-drug regimen (aprepitant + serotonin receptor antagonist (5HT3RA) + dexamethasone) showed better efficacy than a two-drug regimen (5HT3RA + dexamethasone) for CINV prevention without increasing the frequency in adverse events. CONCLUSIONS The aprepitant-based three-drug regimen should be the regimen of choice for CINV prophylaxis for MM patients undergoing autologous SCT with HDMel conditioning.
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Affiliation(s)
- Andrea Tendas
- Hematology Division, S. Eugenio Hospital, Piazzale dell'Umanesimo 10, 00144, Rome, Italy.
| | | | | | - Ombretta Annibali
- Hematology and Stem Cell Transplantation Unit, University Campus Bio-medico, Rome, Italy
| | - Valeria Tomarchio
- Hematology and Stem Cell Transplantation Unit, University Campus Bio-medico, Rome, Italy
| | | | | | | | | | | | - Luca Cupelli
- Hematology Division, S. Eugenio Hospital, Piazzale dell'Umanesimo 10, 00144, Rome, Italy
| | - Antoine Bruno
- Hematology, Rome Transplant Network, Department of Hematology, Stem Cell Transplant Unit, Tor Vergata University, Rome, Italy
| | - Gottardo De Angelis
- Hematology, Rome Transplant Network, Department of Hematology, Stem Cell Transplant Unit, Tor Vergata University, Rome, Italy
| | - Luciano Delbono
- Wake Forest University School of Medicine, Winston Salem, NC, USA
| | - Pasquale Niscola
- Hematology Division, S. Eugenio Hospital, Piazzale dell'Umanesimo 10, 00144, Rome, Italy
| | - Alessio Pio Perrotti
- Hematology Division, S. Eugenio Hospital, Piazzale dell'Umanesimo 10, 00144, Rome, Italy
| | - Paolo de Fabritiis
- Hematology Division, S. Eugenio Hospital, Piazzale dell'Umanesimo 10, 00144, Rome, Italy
| | - William Arcese
- Hematology, Rome Transplant Network, Department of Hematology, Stem Cell Transplant Unit, Tor Vergata University, Rome, Italy
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Tendas A, Marchesi F, Annibali O, Saltarelli D, Niscola P, Perrotti AP, Arcese W. Chemotherapy-induced Nausea and Vomiting Prophylaxis in High-dose Melphalan and Autologous Stem Cell Transplantation. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2018; 18:161-162. [PMID: 29339042 DOI: 10.1016/j.clml.2017.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 12/18/2017] [Indexed: 11/27/2022]
Affiliation(s)
- Andrea Tendas
- Department of Hematology, S. Eugenio Hospital, Rome, Italy.
| | - Francesco Marchesi
- Department of Hematology, Regina Elena National Cancer Institute, Rome, Italy
| | - Ombretta Annibali
- Hematology and Stem Cell Transplantation Unit, University Campus Bio-medico, Rome, Italy
| | - Debora Saltarelli
- Department of Hematology, San Giovanni-Addolorata Hospital, Rome, Italy
| | | | | | - William Arcese
- Department of Hematology, Rome Transplant Network, Department of Haematology, Stem Cell Transplant Unit, Tor Vergata University, Rome, Italy
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Lorusso V, Karthaus M, Aapro M. Review of oral fixed-dose combination netupitant and palonosetron (NEPA) for the treatment of chemotherapy-induced nausea and vomiting. Future Oncol 2014; 11:565-77. [PMID: 25360998 DOI: 10.2217/fon.14.260] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Current guidelines recommend the combination of a neurokinin-1 (NK1) receptor antagonist (RA) and a 5-hydroxytryptamine-3 (5-HT3) RA, together with corticosteroids, in order to prevent chemotherapy-induced nausea and vomiting with anthracycline-cyclophosphamide and highly emetogenic chemotherapy, and it is to be considered with moderately emetogenic chemotherapy. Netupitant and palonosetron (NEPA) is a fixed-dose combination of netupitant, a novel, highly selective NK1 RA, and palonosetron, a new-generation 5-HT3 RA, targeting two major emetic pathways in a single oral capsule. In clinical trials, NEPA administered on day 1 together with dexamethasone was highly effective and well tolerated in the prevention of chemotherapy-induced nausea and vomiting in patients with solid tumors undergoing moderately emetogenic chemotherapy or highly emetogenic chemotherapy. NEPA offers maximal convenience, and as a simple guideline-based regimen, has the potential to improve adherence to guidelines.
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Affiliation(s)
- Vito Lorusso
- Medical Oncology Unit, National Cancer Institute Giovanni Paolo II, 70124 Bari, Italy
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