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

Table 1

Key recommendations of antiemetic guideline groups.

Emetic risk category	MASCC/ESMO (2010) [3]		ASCO (2011) [4]		NCCN (2014) [5]
	Day 1	Days 2-3	Day 1	Days 2-3	Day 1	Days 2-3
High	NK1 RA + 5-HT3 RA + DEX	NK1 RA^a + DEX	Same as MASCC	Same as MASCC	Same as MASCC^c or olanzapine + PALO + DEX	NK1 RA^a + DEX^d or olanzapine^e
AC	NK1 RA + 5-HT3 RA + DEX	NK1 RA^a	Same as MASCC^b	DEX + NK1 RA^a	Same as MASCC^c or olanzapine + PALO + DEX	Same as MASCC^d or olanzapine^g
Moderate	PALO + DEX	DEX	Same as MASCC	Same as MASCC	Same as MASCC^c or NK1 RA + 5-HT3 RA + DEX^f (in select patients)	5-HT3 RA^h or DEX
Low	DEX or 5-HT3 RA or DRA	No routine prophylaxis	DEX	Same as MASCC	Same as MASCC^i	Same as MASCC
Minimal	No routine prophylaxis	No routine prophylaxis	Same as MASCC	Same as MASCC	Same as MASCC	Same as MASCC

 ^aNK₁ RA (aprepitant) is given only if aprepitant was given on Day 1; if fosaprepitant was used then no follow-up NK₁ RA is administered.
^bAC is classified as highly emetogenic.
^cPalonosetron is preferred 5-HT₃.
^dGiven on Days 2–4 (i.e., an additional day).
^eIf olanzapine regimen was given on Day 1.
^fAs per highly emetogenic recommendations an NK₁ regimen should be administered with certain MEC agents (e.g., carboplatin, doxorubicin, epirubicin, ifosfamide, irinotecan, and methotrexate).
^gIf olanzapine was given on Day 1.
^hOnly an option if a 5-HT₃ other than PALO was used on Day 1.
ⁱSpecifically metoclopramide or prochlorperazine.
AC: anthracycline cyclophosphamide; NK₁ RA: neurokinin 1 receptor antagonist; 5-HT₃ RA: serotonin receptor antagonist; DEX: dexamethasone; DRA: dopamine receptor antagonist; PALO: palonosetron.