Navari Rudolph M, Tyler Timothy, Inui Naoki, Iihara Hirotoshi, Bonizzoni Erminio, Park Yeon Hee, Rugo Hope S, Roeland Eric J
Center for Global Cancer Control, World Health Organization, Mount Olive, AL, USA.
Comprehensive Cancer Center, Desert Regional Medical Center, Palm Springs, CA, USA.
Future Oncol. 2025 Sep;21(21):2823-2833. doi: 10.1080/14796694.2025.2542108. Epub 2025 Aug 9.
Because no conclusive data demonstrate superiority among NK receptor antagonists (RA), existing antiemetic guidelines regard them as interchangeable. This individual patient data (IPD) meta-analysis compared the efficacy of NEPA (netupitant/fosnetupitant) and aprepitant/fosaprepitant-based regimens in preventing chemotherapy-induced nausea and vomiting (CINV).
MATERIALS & METHODS: Head-to-head comparative studies published between 2003 and 2022 that evaluated antiemetic prophylaxis of aprepitant or fosaprepitant versus oral or intravenous (IV) NEPA in patients with various cancers receiving highly (HEC) or moderately emetogenic chemotherapy (MEC) were identified through a literature search. We combined individual patient data to assess complete response (no emesis/no rescue medication) and no significant nausea using a two-stage approach.
A total of six studies involving 2,767 patients were included evaluating NEPA plus dexamethasone versus aprepitant/fosaprepitant plus any 5-HTRA plus dexamethasone for patients with cancer receiving HEC/MEC. Complete response and no significant nausea rates were similar during the acute (0-24 h) phase but NEPA showed significantly higher rates than aprepitant during the delayed ( > 24-120 h) and overall (0-120 h) phases and on Days 3-5 following chemotherapy.
Improved CINV prevention was observed with NEPA-based regimens, particularly during Days 3-5, highlighting its potential for managing prolonged nausea and vomiting associated with emerging anticancer targeted therapies.
由于尚无确凿数据表明NK受体拮抗剂（RA）之间存在优越性，现有的止吐指南认为它们可相互替代。本个体患者数据（IPD）荟萃分析比较了奈妥吡坦/福沙吡坦（NEPA）与基于阿瑞匹坦/福沙匹坦的方案在预防化疗引起的恶心和呕吐（CINV）方面的疗效。
通过文献检索，确定了2003年至2022年间发表的对头比较研究，这些研究评估了阿瑞匹坦或福沙匹坦与口服或静脉注射（IV）NEPA在接受高致吐性化疗（HEC）或中度致吐性化疗（MEC） 的各类癌症患者中的止吐预防效果。我们采用两阶段方法合并个体患者数据，以评估完全缓解（无呕吐/无救援药物）和无明显恶心的情况。
共纳入6项研究，涉及2767例患者，评估了NEPA加地塞米松与阿瑞匹坦/福沙匹坦加任何5-羟色胺受体拮抗剂加地塞米松在接受HEC/MEC的癌症患者中的疗效。在急性（0-24小时）期，完全缓解率和无明显恶心率相似，但在延迟（>24-120小时）期和总体（0-120小时）期以及化疗后第3-5天，NEPA的发生率显著高于阿瑞匹坦。
基于NEPA的方案在预防CINV方面有改善，尤其是在第3-5天，突出了其在管理与新兴抗癌靶向治疗相关的长期恶心和呕吐方面的潜力。
