This slideshow reviews the latest clinical updates surrounding the management of treatment-associated nausea and vomiting, including recommendations, newly approved agents, and more.
Nausea and vomiting are known unwanted side effects associated with cancer treatment, including chemotherapy. In some cases, chemotherapy-induced nausea and vomiting (CINV) can be debilitating for patients, and prevention is key. These slides provide insight into CINV management, recent drug approvals in this area, and current treatment recommendations.
1. FDA Approves Fosnetupitant and Palonosetron to Prevent Chemotherapy-Induced Nausea and Vomiting in Adults. On April 18, 2019, the US Food and Drug Administration (FDA) approved combination intravenous (IV) fosnetupitant and palonosetron as a preventative anti-emetic therapy in adults receiving chemotherapy. The approval was based on the results of several trials, mainly the PALO-15-17 trial (ClinicalTrials.gov identifier: NCT02557035) and the NEPA-15-18 trial (ClinicalTrials.gov identifier: NCT02517021). The PALO-15-17 trial was conducted to establish the benefits of this therapy, while the NEPA-15-18 trial was conducted to establish its side effects. The combination treatment is given by IV infusion, in combination with dexamethasone, 30 minutes prior to chemotherapy initiation. (Source)
2. Concerns Raised About Safety of Rolapitant in FDA Statement. In January 2018, the FDA released a safety information statement on the injectable drug rolapitant. The substance P/neurokinin-1 (NK-1) receptor antagonist is currently indicated for use in adults to prevent delayed CINV. The safety statement warned of the potential for anaphylaxis, anaphylactic shock, and other serious hypersensitivity reactions based on post-marketing reports. (Source)
3. Daily Probiotics May Relieve GI Symptoms in Pediatric Leukemia Patients. The results of a recent randomized pilot study evaluating probiotics, specifically Lactobacillus rhamnosus, in children with acute leukemia support the use of daily probiotics to relieve treatment-induced gastrointestinal (GI) symptoms. Researchers noted the negative effects on gut microbiota in children treated with chemotherapy, thus assessing the effects of probiotic supplementation in this patient population. They also found a lowered prevalence of GI side effects, especially of nausea, vomiting, and abdominal distension. (Source)
4. Acupressure Bands and Relaxation May Benefit Breast Cancer Patients With CINV. According to a new study, patients at risk for CINV may benefit from the use of acupressure bands and relaxation recordings as a preventative measure. Specifically, researchers found that breast cancer patients with a high CINV expectation during treatment with doxorubicin or high levels of anxiety experienced reduced levels of CINV when acupressure bands combined with a relaxation recording were utilized. (Source)
5. ASCO Endorses Integrative Therapy for Breast Cancer Patients. The American Society of Clinical Oncology (ASCO) released a statement last year that it endorses the Society for Integrative Oncology’s (SIO’s) clinical practice guidelines for integrative therapies for patients during and following treatment of breast cancer, so long as the integrative therapies are discussed with the patient’s healthcare team. Key recommendations from SIO for the treatment of CINV include acupressure and acupuncture. (Source)
6. FDA Expands Approval of Aprepitant in Acute and Delayed CINV. On February 26, 2019, the FDA expanded its approval of IV aprepitant to include a 2-minute injection of the drug for use in patients to prevent acute and delayed CINV. The approval was based on the results of a study which showed that the 2-minute IV injection was comparable in terms of safety and bioequivalence to a 30-minute IV infusion of the same agent. (Source)