Helsinn was pleased to be present at the recent European Society for Medical Oncology (ESMO) annual congress, one of most influential (EU) oncology scientific platform for healthcare providers from all over the world.

While improving the treatment outcomes, the adoption of new therapies, such as antibody drug conjugates (ADCs), reveals a new challenge for patients and healthcare providers in side effect management. A growing body of compelling evidence indicates that nausea and vomiting are among the most common toxicities associated with some ADCs, such as trastuzumab deruxtecan (T-DXd), with nausea being problematic and long-lasting for patients.

In a poster presentation at ESMO, Dr. Luca Licata’s group shared the results of the first study that evaluates NEPA for managing AEs of T-DXd. Most patients in this small study received NEPA as “rescue” treatment in cycle 2 after receiving only a 5-HT₃ receptor antagonist (RA) ± dexamethasone in cycle 1. In this subset, the introduction of NEPA resulted in a significant reduction in both nausea and vomiting in cycle 2 compared to the 5-HT₃ RA group.  In the subset who received NEPA in cycle 1, there was a trend toward lower grade nausea for NEPA-treated patients and a borderline significant difference favoring NEPA over a 5-HT₃ RA in the proportion of patients experiencing vomiting (0% NEPA vs 21% 5-HT₃ RA, p = 0.054). The results of this study suggest that NEPA is a beneficial antiemetic that can be used as prophylaxis for patients receiving T-DXd. 

While Dr. Licata’s study did not look specifically at the duration of nausea, the emerging data with ADCs suggests that nausea can last much longer than what has been seen with traditional chemotherapy.^4-5 Therefore, research has begun to focus on evaluating the prevalence of nausea and vomiting beyond the conventional delayed phase (defined as 25-120 hours after chemotherapy).^1-3

In another poster presentation, Dr. Scotté described the results of a large survey of healthcare providers in Japan, which assessed whether they observe patients who are experiencing nausea and vomiting on days 5-7 post-chemotherapy. In this large survey of over 800 participants the majority of pharmacists (98%), nurses (93%), and physicians (88%) indicated that their patients are experiencing nausea and vomiting beyond the delayed phase.

Putting this into perspective: Awareness of the pattern and importance of nausea (and vomiting) associated with ADCs is lagging but new data are continuing to emerge. The fact that nausea is persisting in some patients beyond the traditional delayed phase suggests that an antiemetic with long-lasting effect would be advantageous. New studies are also being done to investigate the occurrence of “long-delayed CINV”, which will further highlight this emerging unmet need associated with the ADCs side effect profile.

Helsinn is dedicated to enhancing the quality of life for patients undergoing emetogenic cancer treatment by providing continuous support of research aimed at addressing unmet needs and expanding on the benefits of NEPA (netupitant/palonosetron).

References:

1. Zelek L, Navari R, Aapro M, Scotté F. Single-dose NEPA versus an aprepitant regimen for prevention of chemotherapy-induced nausea and vomiting in patients receiving moderately emetogenic chemotherapy. Cancer Med. 2023 Aug;12(15):15769-15776.
2. Hata A, Shiraishi Y, Inui N, Okada M, Morise M, Akiyoshi K, Takeda M, Watanabe Y, Sugawara S, Shinagawa N, Kubota K, Saeki T, Tamura T. Exploratory Analysis Comparing Fosnetupitant Versus Fosaprepitant for Prevention of Highly Emetogenic Chemotherapy-Induced Nausea and Vomiting (CINV): A Randomized, Double-Blind, Phase 3 Study (CONSOLE). Oncol Ther. 2022 Jun;10(1):253-262. 
3. Chow R, Yin LB, Baqri W, Huang R, Boldt G, Younus J, Lock M, Prsic E, Zimmermann C, Herrstedt J. Prevalence and predictors of long-delayed (> 120 h) chemotherapy-induced nausea and vomiting (CINV)-a systematic review and individual patient data meta-analysis. Support Care Cancer. 2023 Aug 3;31(8):505.
4. Rugo H, et al. ESMO Breast 2023; Oral Presentation #1850
5. Rugo HS, Bianchini G, Cortes J, Henning JW, Untch M. Optimizing treatment management of trastuzumab deruxtecan in clinical practice of breast cancer. ESMO Open. 2022 Aug;7(4):100553.