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BioMed Research International
Volume 2015, Article ID 651879, 12 pages
Review Article

A Review of NEPA, a Novel Fixed Antiemetic Combination with the Potential for Enhancing Guideline Adherence and Improving Control of Chemotherapy-Induced Nausea and Vomiting

1Lahey Hospital & Medical Center, 41 Mall Road, Burlington, MA 01805, USA
2Institut Multidisciplinaire d’Oncologie, Clinique de Genolier, Case Postale 100, Route du Muids 3, 1272 Genolier, Switzerland
3Department of Internal Medicine IV, Hematology/Oncology, Martin-Luther-University Halle/Wittenberg, Ernst-Grube-Straße 40, 06120 Halle, Germany
4The West Clinic, 100 Humphreys Boulevard, Memphis, TN 38120, USA
5Institute for Oncology and Radiology of Serbia, Pasterova 14, 11000 Belgrade, Serbia
6University of California San Francisco Helen Diller Family Comprehensive Cancer Center, 1600 Divisadero Street, P.O. Box 1710, San Francisco, CA 94115, USA

Received 18 November 2014; Revised 20 February 2015; Accepted 25 February 2015

Academic Editor: Min Li

Copyright © 2015 Paul J. Hesketh et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Combination antiemetic regimens targeting multiple molecular pathways associated with emesis have become the standard of care for prevention of chemotherapy-induced nausea and vomiting (CINV) related to highly and moderately emetogenic chemotherapies. Antiemetic consensus guidelines from several professional societies are widely available and updated regularly as new data emerges. Unfortunately, despite substantial research supporting the notion that guideline conformity improves CINV control, adherence to antiemetic guidelines is unsatisfactory. While studies are needed to identify specific barriers to guideline use and explore measures to enhance adherence, a novel approach has been taken to improve clinician adherence and patient compliance, with the development of a new combination antiemetic. NEPA is an oral fixed combination of a new highly selective NK1 receptor antagonist (RA), netupitant, and the pharmacologically and clinically distinct 5-HT3 RA, palonosetron. This convenient antiemetic combination offers guideline-consistent prophylaxis by targeting two critical pathways associated with CINV in a single oral dose administered only once per cycle. This paper will review and discuss the NEPA data in the context of how this first combination antiemetic may overcome some of the barriers interfering with adherence to antiemetic guidelines, enhance patient compliance, and offer a possible advance in the prevention of CINV for patients.