The American Society of Clinical Oncology (ASCO) has updated their antiemetic guideline regarding the use of palonosetron and netupitant in combination to treat nausea and vomiting in patients receiving chemotherapy.1

The committee responsible for the updated recommendation, chaired by Paul J. Hesketh, Lahey Hospital and Medical Center, Burlington, Massachusetts, and Mark G. Kris, Memorial Sloan Kettering Cancer Center, New York City, reviewed 2 phase 3 trials, found via literature review.

In one trial, an oral combination of palonosetron and netupitant was deemed effective across multiple cycles of moderately or highly emetogenic chemotherapies. The second trial compared an oral combination of netupitant and palonosetron with palonosetron alone in patients treated with anthracycline plus cyclophosphamide; the combination demonstrated higher complete response rates. The committee also reviewed a phase 2 study that examined the effectiveness of netupitant (coadministered with palonosetron 0.50 mg) vs palonosetron alone; the netupitant doses were found to be more effective, with greatest efficacy in the highest dose (300 mg).

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The committee recommends that patients receiving highly emetogenic chemotherapy regimens be offered a combination of a NK1 receptor antagonist, a 5-HT3 receptor antagonist, and dexamethasone, with netupitant and palonosetron plus dexamethasone (oral combination) also being an option for additional therapy. The update committee otherwise did not recommend deviations from 2011 ASCO guideline at this time.


1. Hesketh PJ, Bohlke K, Lyman GH, et al. Antiemetics: American Society of Clinical Oncology focused guideline update [published online ahead of print November 2, 2015]. J Clin Oncol. doi.10.1200/JCO.2015.64.3635.