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.

由于尚无确凿数据证实NK₁受体拮抗剂（NK₁ receptor antagonists）之间存在疗效优势，现行止吐指南（antiemetic guidelines）将其视为可互换药物。本项个体患者数据（individual patient data, IPD）荟萃分析比较了NEPA（奈妥匹坦/福奈妥匹坦，netupitant/fosnetupitant）与阿瑞匹坦/福沙匹坦方案在预防化疗所致恶心呕吐（chemotherapy-induced nausea and vomiting, CINV）中的疗效。通过文献检索，我们纳入了2003年至2022年间发表的头对头比较研究，这些研究评估了在接受高致吐性化疗（highly emetogenic chemotherapy, HEC）或中致吐性化疗（moderately emetogenic chemotherapy, MEC）的各类癌症患者中，阿瑞匹坦或福沙匹坦与口服或静脉注射（intravenous, IV）NEPA的止吐预防方案对比效果。我们采用两阶段法整合个体患者数据，以评估完全缓解（无呕吐/无解救用药）及无显著恶心的情况。最终纳入6项共涉及2767例患者的研究，对比了NEPA联合地塞米松与阿瑞匹坦/福沙匹坦联合任意5-HT₃受体拮抗剂（5-HT₃ receptor antagonists, 5-HT₃RA）联合地塞米松的方案，用于接受HEC/MEC的癌症患者。急性期（0~24小时）的完全缓解率与无显著恶心率两组相似，但NEPA在延迟期（>24~120小时）、总观察期（0~120小时）以及化疗后第3~5日的上述指标均显著优于阿瑞匹坦。基于NEPA的止吐方案可更有效地预防CINV，尤其在化疗后第3~5日，这凸显了其在管理与新兴抗肿瘤靶向治疗相关的持续性恶心呕吐中的应用潜力。本研究针对两类用于缓解癌症患者化疗期间不适的止吐药物展开评估，二者均旨在抑制恶心与呕吐：一类为NEPA，另一类为阿瑞匹坦，两类药物均可通过口服或静脉注射给药。所有入组患者均联合使用了其他常用的副作用辅助治疗药物。研究人员共纳入6项研究、2767例患者，旨在比较两种药物的临床疗效。结果显示，化疗首日两组疗效无显著差异，但在化疗后数日，NEPA的疗效更优：其可更有效地预防呕吐与重度恶心，且需额外使用解救药物的患者比例更低，该优势在化疗后第2至第5日均有体现。本研究表明，NEPA可更有效地缓解化疗相关不良反应的长期症状，对于使用可引发持续性恶心的新型抗肿瘤药物的患者而言，该方案尤为适用。