As an oncology pharmacist, you will hear about the new ORAL antiemetic combo, Akynzeo. It will increase options to prevent chemo-induced nausea and vomiting (CINV). Akynzeo is the 5-HT3 antagonist palonosetron (Aloxi) plus a new long-acting neurokinin-1 antagonist, netupitant.
Think of netupitant as an alternative to aprepitant (Emend). These help boost the efficacy of 5-HT3 antagonists. Antiemetic regimens are picked based on the chemotherapy regimen and previous response. Reassure patients that oral antiemetics work well...
HIGH emetogenic chemotherapy (cisplatin, etc) usually needs THREE medications. Expect to see aprepitant (Emend), a 5-HT3 antagonist like ondansetron (Zofran), palonosetron (Aloxi), and dexamethasone before chemotherapy, then aprepitant (Emend) and dexamethasone for 2 days after chemotherapy. You may also see olanzapine (Zyprexa, Olapex, etc) tried instead of aprepitant. It seems to work as well and it's less expensive.
MODERATE emetogenic chemotherapy (oxaliplatin, etc) can usually be managed with TWO medications. This is usually a 5-HT3 as palonosetron (Aloxi) plus dexamethasone before chemotherapy, and either a 5-HT3 OR dexamethasone for 2 days after chemotherapy. Add aprepitant (Emend) if dual therapy isn't enough.
LOW emetogenic chemotherapy (paclitaxel, etc) usually needs just ONE medication. This is often a single dose of dexamethasone or a 5-HT3 antagonist, prochlorperazine, or metoclopramide (Primpran) if a steroid can't be used. Consider Akynzeo as an alternative to a 5-HT3 plus aprepitant. Remember, the cost of Akynzeo for one cap is much more than the cost of aprepitant (Emend) PLUS ondansetron (Zofran), and it lasts 3 days.
REFERENCES
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Nausea and Vomiting Related to Cancer Treatment (PDQ)–Health Professional Version - National Cancer Institute. [online] Available at: https://www.cancer.gov/about-cancer/treatment/side-effects/nausea/nausea-hp-pdq#section/all
Drug Trials Snapshots: AKYNZEO. FDA. [online] Available at: https://www.fda.gov/drugs/drug-approvals-and-databases/drug-trials-snapshots-akynzeo
Basch E, Prestrud AA, Hesketh PJ, Kris MG, Feyer PC, Somerfield MR, Chesney M, Clark-Snow RA, Flaherty AM, Freundlich B, Morrow G, Rao KV, Schwartz RN, Lyman GH; American Society of Clinical Oncology. Antiemetics: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol. 2011 Nov 1;29(31):4189-98. Available at: https://ascopubs.org/doi/10.1200/JCO.2010.34.4614?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed