In an update on key guidelines for antiemetic use, American Society of Clinical Oncology (ASCO) researchers recommended that patients who receive highly emetogenic chemotherapy regimens be offered a 3-drug combination of an NK1 receptor, a 5-HT3 receptor antagonist, and dexamethasone. The recommendation was published online ahead of print in the Journal of Clinical Oncology.1

An update committee led by Paul Hesketh, MD, of ASCO based in Alexandria, VA, conducted a systematic literature review of two phase 3 clinical trials and a randomized phase 2 dose-ranging study.

In order to update a key recommendation of the 2011 ASCO antiemetic guideline,the committee wanted to address the use of oral combination netupitant and palonosetron for prevention of acute and delayed nausea and vomiting in patients receiving chemotherapy.

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They found that in one of the phase 3 trials, the oral combination was associated with higher complete response rates compared with palonosetron alone in patients treated with anthracycline plus cyclophosphamide chemotherapy.

In the other phase 3 trial, the combination was found to be safe and effective across multiple cycles of moderately or highly emetogenic chemotherapies.

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Additionally in the phase 2 dose-ranging study, it was found that each dose of netupitant produced higher complete response rates than palonosetron alone in patients receiving cisplatin-based chemotherapy.

“Oral combination of netupitant and palonosetron plus dexamethasone is an additional treatment option in this setting,” researchers concluded. “The remaining recommendations from the 2011 ASCO guideline are unchanged pending a full update.”


  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.