The first American Society of Clinical Oncology (ASCO) guideline for the use of antiemetics was published in 1999, and the guideline was updated in 2006 and again in 2011. ASCO is in the process of fully reviewing and updating the 2011 guideline, and in the meantime, has issued expedited guidance about the use of netupitant and palonosetron (NEPA). NEPA was approved by the FDA in October 2014 for the prevention of acute and delayed nausea and vomiting associated with initial and repeated courses of chemotherapy. NEPA is administered orally and consists of a fixed dose of 300 mg of the neurokinin-1 (NK1) receptor antagonist netupitant combined with 0.50 mg of the 5-hydroxytryptamine type 3 (5-HT3) receptor antagonist palonosetron.
Based on a literature review, ASCO recommends that all patients who receive highly emetogenic chemotherapy regimens should be offered a three-drug combination of an NK1 receptor antagonist, a 5-HT3 receptor antagonist, and dexamethasone. The oral combination of netupitant and palonosetron plus dexamethasone is another treatment option. The remaining recommendations from the 2011 ASCO guideline are unchanged pending a full update. Additional information is available at www.asco.org/guidelines/antiemetics.