Abstract P1-11-10: Efficacy of NEPA as antiemetic prophylaxis in breast cancer patients receiving highly or moderately emetogenic chemotherapy – Interim results of a German prospective, non-interventional study

Abstract

Background The oral fixed dose combination of netupitant and palonosetron NEPA has been approved for the prevention of acute and delayed chemotherapy-induced nausea and vomiting (CINV) in cancer patients receiving cisplatin-based highly emetogenic (HEC) or moderately emetogenic chemotherapy (MEC). The primary objective of the prospective, non-interventional study (NIS) AkyPRO is the evaluation of quality of life in adults receiving MEC or HEC and NEPA for CINV prevention. Secondary endpoints are efficacy and safety of NEPA. Here we present an interim analysis of NEPA efficacy in the subgroup of breast cancer patients, who represent the largest subgroup (66%) of enrolled patients. Since September 2015, 2427 patients have been enrolled, of whom 986 are breast cancer patients. Methods The NIS has been designed to evaluate NEPA in 2,500 cancer patients receiving single day or two day MEC or HEC. QoL is recorded by FLIE questionnaires. Efficacy (complete response (CR, no vomiting, no rescue medication)), additional medication, and adverse events are recorded in patient diaries over three consecutive chemotherapy cycles. Additionally, physicians report their efficacy assessments of NEPA online, using an eCRF. Results At the cut-off date November 11, 2017, 2427 patients had been enrolled in the study. For the interim analysis 986 breast cancer patients were evaluated who had been fully documented in the eCRF at the cut-off date. 95% had an ECOG performance status of 0 or 1. 51% received adjuvant, 44% neoadjuvant, and 5% palliative chemotherapy. 80% of patients received HEC, mostly (79%) anthracycline/cyclophosphamide (AC) combinations. Of the women receiving MEC, the majority were treated with carboplatin-based regimens (9%). 7% of patients received other MEC regimens. 81.4-82.8 % of patients reported CR in cycles 1-3 and more than 93% of patients reported no emesis during the 3 treatment cycles covered in the patient diaries. No significant nausea was reported by 62.7-64.2% of patients. Physicians rated the efficacy of the antiemetic prophylaxis with NEPA using the 4 categories very good, good, satisfactory, and poor. In cycles 1 and 2, more than 89% of physicians rated the efficacy of NEPA very good or good. In cycle 3, 90.6% rated it very good or good. In addition to reporting CR, nausea and emesis episodes in their patient diaries, patients used the same 4 categories to assess the efficacy of NEPA at the end of each treatment cycle. Efficacy assessments of physicians and patients were very similar, with 87% of patients choosing very good or good in cycle 1 compared to 89% of physicians. NEPA was well tolerated. Low-grade constipation (14.9%) and insomnia (8.3%) were the most frequent treatment-related adverse event. Conclusion In this real life study, NEPA was effective in the prevention of CINV in the subgroup of breast cancer patients receiving HEC or MEC. The efficacy assessments by patients and physicians were comparable, with approximately 90% good or very good efficacy for 3 consecutive cycles. More than 93% of patients reported no emesis and more than 81% reported CR during the 5 days post-chemotherapy during all 3 cycles. The study is ongoing. Citation Format: Schilling J, Hielscher C, Hanusch C, Kurbacher C, Busch S, Karthaus M. Efficacy of NEPA as antiemetic prophylaxis in breast cancer patients receiving highly or moderately emetogenic chemotherapy – Interim results of a German prospective, non-interventional study [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P1-11-10.

Update Breast Cancer 2019 Part 2 – Implementation of Novel Diagnostics and Therapeutics in Advanced Breast Cancer Patients in Clinical Practice

“…In the era prior to the introduction of the 5-HT3 receptor antagonists, vomiting was usually reported in more than 60% of patients during standard chemotherapy for breast cancer patients 85 . Nowadays, these rates are significantly lower in routine clinical practice with the aid of prophylaxis with steroids, 5-HT3 receptor antagonists and neurokinin-1 (NK1) receptor antagonists, as recommended in current guidelines 75 and as described in a large study 86 . An analysis of nearly 1000 breast cancer patients (n = 986) who received standard chemotherapy and the combination preparation NEPA (netupitant + palonosetron) was able to show that vomiting occurred in only about 10% of the women and nausea in about 30 – 40% of the patients 86 .…”

“…Nowadays, these rates are significantly lower in routine clinical practice with the aid of prophylaxis with steroids, 5-HT3 receptor antagonists and neurokinin-1 (NK1) receptor antagonists, as recommended in current guidelines 75 and as described in a large study 86 . An analysis of nearly 1000 breast cancer patients (n = 986) who received standard chemotherapy and the combination preparation NEPA (netupitant + palonosetron) was able to show that vomiting occurred in only about 10% of the women and nausea in about 30 – 40% of the patients 86 . This emphasises the significant advancements in the supportive therapy of this adverse effect which still had a significant influence on patientsʼ quality of life on chemotherapy just a few decades ago.…”

“…In der Ära vor der Einführung der 5-HT3-Rezeptor-Antagonisten wurde bei einer Standardchemotherapie für Mammakarzinompatientinnen in der Regel Erbrechen in über 60% der Patientinnen berichtet 85 . Heutzutage sind diese Raten mithilfe einer Prophylaxe mit Steroiden, 5-HT3-Rezeptoranagonisten und Neurokinin-1-(NK1-)Rezeptor-Antagonisten, wie in aktuellen Leitlinien empfohlen 75 und in einer großen Studie in der klinischen Routine beschrieben 86 , deutlich niedriger. Eine Analyse von fast 1000 Mammakarzinompatientinnen (n = 986), die eine Standardchemotherapie und das Kombinationspräparat NEPA (Netupitant + Palonosetron) erhalten haben, konnte zeigen, dass Erbrechen in nur ca.…”

“…10% der Frauen und Übelkeit in ca. 30 – 40% der Patientinnen 86 auftrat. Dies verdeutlicht die großen Fortschritte bei der supportiven Therapie dieser Nebenwirkung, die vor wenigen Jahrzehnten noch einen deutlichen Einfluss auf die Lebensqualität von Patientinnen unter Chemotherapie hatte.…”

Update Mammakarzinom 2019 Teil 2 – Implementierung neuer Diagnostika und Therapien bei Patientinnen mit fortgeschrittenem Brustkrebs in der klinischen Praxis

“…In der Ära vor der Einführung der 5-HT3-Rezeptor-Antagonisten wurde bei einer Standardchemotherapie für Mammakarzinom-Patientinnen in der Regel Erbrechen in über 60 % der Patientinnen berichtet [85]. Heutzutage sind diese Raten mithilfe einer Prophylaxe mit Steroiden, 5-HT3-Rezeptoranagonisten und Neurokinin-1 (NK1) -Rezeptor-Antagonisten, wie in aktuellen Leitlinien empfohlen [75] und in einer großen Studie in der klinischen Routine beschrieben [86], deutlich niedriger. Eine Analyse von fast 1000 Mammakarzinom-Patientinnen (n = 986), die eine Standardchemotherapie und das Kombinationspräparat NEPA (Netupitant + Palonosetron) erhalten haben, konnte zeigen, dass Erbrechen in nur ca.…”