Chemotherapy-induced
nausea (CIN) has a significant negative impact on the quality of life of
cancer patients. The use of 5-hydroxytryptamine-3 (5-HT3) receptor antagonists (RAs) has reduced the risk of
vomiting, but (except for
palonosetron) their effect on
nausea, especially delayed
nausea, is limited. This article reviews the role of NK1RAs when combined with 5-HT3RA-dexamethasone in CIN prophylaxis.
Aprepitant has not shown consistent superiority over a two-drug (
ondansetron-
dexamethasone) combination in
nausea control after
cisplatin- or
anthracycline-
cyclophosphamide (AC)-based highly emetogenic
chemotherapy (HEC). Recently,
dexamethasone and
dexamethasone-
metoclopramide were demonstrated to be non-inferior to
aprepitant and
aprepitant-
dexamethasone, respectively, for the control of delayed
nausea after HEC (AC/
cisplatin), and are now recognized in the guidelines. The potential impact of the new NK1RAs
rolapitant and
netupitant (oral fixed combination with
palonosetron, as NEPA) in CIN prophylaxis is discussed. While the clinical significance of the effect on
nausea of the
rolapitant-
granisetron-
dexamethasone combination after
cisplatin is not conclusive,
rolapitant addition showed no improvement in
nausea prophylaxis after AC or moderately emetogenic
chemotherapy (MEC). NEPA was superior to
palonosetron in the control of
nausea after HEC (AC/
cisplatin). Moreover, the efficacy of NEPA in
nausea control was maintained over multiple cycles of HEC/MEC. Recently, NK1RAs have been challenged by
olanzapine, with
olanzapine showing superior efficacy in
nausea prevention after HEC. Fixed
antiemetic combinations (such as NEPA) or new
antiemetics with a long half-life that may be given once per
chemotherapy cycle (
rolapitant or NEPA) may improve patient compliance with
antiemetic treatment.