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Akynzeo Added to ASCO Guidelines for Chemo-Induced Nausea and Vomiting

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The agent Akynzeo (netupitant and palonostron) has been added to guidelines proposed by the American Society of Clinical Oncology (ASCO) “for the prevention of acute and delayed nausea and vomiting (emesis) in patients receiving chemotherapy.”

The American Society of Clinical Oncology (ASCO) provides recommended treatment and supportive care guidelines for oncology healthcare providers. The guideline recommendations are based on data from literature reviews, including phase III and phase II dose-ranging studies. If results indicate an improvement of specific treatment over standard care, guidelines are updated to reflect these changes.

Chemotherapy is often associated with causing nausea and vomiting. Acute and delayed-phase nausea and vomiting are two common types of caused by chemotherapy.

Acute-phase nausea and vomiting occurs a few minutes to hours after chemotherapy. It typically resolves within 24 hours after chemotherapy, with the worst symptoms often being 5-6 hours after chemotherapy.

Delayed-phase nausea and vomiting occurs more than 24 hours after chemotherapy. It is usually worst at 48-72 hours after chemotherapy, and can last for 6-7 days.

Different types of nausea and vomiting are caused through different biologic pathways in the body and therefore, different anti-emetic drugs are necessary to prevent or treat the different types.

Nausea and vomiting is not only associated with an extreme reduction in quality of life, but can also result in severe health-related consequences. Dehydration, electrolyte imbalances, and forms of malnutrition are associated with nausea and vomiting, which can lead to hospitalization, extreme fatigue, and the inability to receive optimal therapeutic doses or frequency of treatment. Therefore, the prevention of both phases of nausea and vomiting caused by chemotherapy is an important supportive care measure for cancer patients.

Akynzeo is an agent that includes both anti-emetic agents, palonosetron and netupitant. Palonosetron is a 5-HT3 receptor antagonist that prevents nausea and vomiting during the acute phase. Netupitant is a NK1 receptor antagonist that prevents nausea and vomiting during both acute and delayed phases.

Akynzeo is already approved for the prevention of acute and delayed nausea and vomiting associated with initial and repeat courses of cancer chemotherapy, including, but not limited to, highly emetogenic chemotherapy (meaning the chemotherapy is strongly associated with nausea and vomiting).

The 2015 ASCO guidelines recommend the following change for chemotherapy-induced nausea and vomiting: “All patients who receive highly emetogenic chemotherapy regimens (including anthracycline plus cyclophosphamide) should be offered a three-drug combination of an NK1 receptor antagonist, a 5-HT3 receptor antagonist, and dexamethasone. The oral combination of netupitant and palonosetron plus dexamethasone is an additional treatment option in this setting. The remaining recommendations from the 2011 ASCO guideline are unchanged pending a full update.”

Reference: Hesketh P, Bohlke K, Lyman G, et al. Antiemetics: American Society of Clinical Oncology Focused Guidelines Update. Journal of Clinical Oncology. Published online before print November 2, 2015, doi: 10.1200/JCO.2015.64.3635
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