Individual patient data meta-analysis of NEPA versus aprepitant-based antiemetic regimens for preventing chemotherapy-induced nausea and vomiting

Because no conclusive data demonstrate superiority among NK₁ receptor antagonists (RA), existing antiemetic guidelines regard them as interchangeable. This individual patient data (IPD) meta-analysis compared the efficacy of NEPA (netupitant/fosnetupitant) and aprepitant/fosaprepitant-based regimens in preventing chemotherapy-induced nausea and vomiting (CINV). Head-to-head comparative studies published between 2003 and 2022 that evaluated antiemetic prophylaxis of aprepitant or fosaprepitant versus oral or intravenous (IV) NEPA in patients with various cancers receiving highly (HEC) or moderately emetogenic chemotherapy (MEC) were identified through a literature search. We combined individual patient data to assess complete response (no emesis/no rescue medication) and no significant nausea using a two-stage approach. A total of six studies involving 2,767 patients were included evaluating NEPA plus dexamethasone versus aprepitant/fosaprepitant plus any 5-HT₃RA plus dexamethasone for patients with cancer receiving HEC/MEC. Complete response and no significant nausea rates were similar during the acute (0–24 h) phase but NEPA showed significantly higher rates than aprepitant during the delayed ( > 24–120 h) and overall (0–120 h) phases and on Days 3–5 following chemotherapy. Improved CINV prevention was observed with NEPA-based regimens, particularly during Days 3–5, highlighting its potential for managing prolonged nausea and vomiting associated with emerging anticancer targeted therapies. This study examined two types of medicine to help cancer patients feel less sick during chemotherapy. Both types try to stop nausea and vomiting. One kind is called NEPA, and the other is called aprepitant. Both include drugs taken by mouth or given through an IV. All patients also took other common medicines to help with side effects. The researchers looked at six studies with a total of 2,767 patients. They wanted to see which medicine worked better. On the first day of chemotherapy, both types worked about the same. But in the days after chemotherapy, NEPA worked better. It helped prevent vomiting and more severe nausea. It also meant fewer people needed extra medicine to feel better. This improvement was true from day 2 to day 5 after treatment. The study shows that NEPA may give better long-term relief from chemotherapy side effects, which may be especially helpful for patients who are using newer cancer drugs that can cause longer-lasting nausea.