Personalised antiemetic prophylaxis with NEPA for patients at high risk of chemotherapy-induced nausea and vomiting receiving moderately emetogenic chemotherapy: results from the randomised, multinational MyRisk trial
Background - Patients receiving moderately emetogenic chemotherapy (MEC) are commonly prescribed a 5-hydroxytryptamine-3 (5-HT3) receptor antagonist (RA) and dexamethasone (DEX) as standard-of-care (SOC) antiemetic prophylaxis. However, in patients with an elevated risk of chemotherapy-induced nause...
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| Auteurs principaux: | , , , , , , , , , , , , , , , , , , , , , , |
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| Format: | Article (Journal) |
| Langue: | anglais |
| Publié: |
February 2026
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| In: |
Annals of oncology
Year: 2026, Volume: 37, Numéro: 2, Pages: 260-270 |
| ISSN: | 1569-8041 |
| DOI: | 10.1016/j.annonc.2025.10.017 |
| Accès en ligne: | Verlag, kostenfrei, Volltext: https://doi.org/10.1016/j.annonc.2025.10.017 Verlag, kostenfrei, Volltext: https://www.sciencedirect.com/science/article/pii/S0923753425049646 
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| Notes sur l'auteur: | A. Molassiotis, K. Jordan, M. Karthaus, G. Dranitsaris, E. J. Roeland, L. Schwartzberg, V. Stimamiglio, A. Alonzi, S. Olivari Tilola, E. Bonizzoni, E. Brozos Vázquez, T. Buchler, Y. Cheng, D.C. Christoph, P. García Alfonso, X. Lu, M. Majem, D. Mavroudis, K. Syrigos, E. Tomlins, Z. Zhou, M. Zimovjanová & M. Aapro |
| Résumé: | Background - Patients receiving moderately emetogenic chemotherapy (MEC) are commonly prescribed a 5-hydroxytryptamine-3 (5-HT3) receptor antagonist (RA) and dexamethasone (DEX) as standard-of-care (SOC) antiemetic prophylaxis. However, in patients with an elevated risk of chemotherapy-induced nausea and vomiting (CINV) due to individual risk factors, prophylaxis with an neurokinin-1 (NK1) RA-containing regimen may optimise their antiemetic prevention. To address this unmet need for a more personalised antiemetic strategy, the MyRisk trial incorporated a predictive risk factor algorithm to select patients at increased risk of CINV who may benefit from enhanced antiemetic prophylaxis. - Patients and methods - MyRisk was a phase IV, randomised, open-label, multicentre, multinational trial. Adult patients scheduled to receive three cycles of MEC with a high-risk CINV score were randomly assigned to NEPA (a fixed combination of an NK1 RA, netupitant, and 5-HT3 RA, palonosetron) + DEX or SOC. The CINV risk score was calculated based on an algorithm that considered seven risk factors. The primary endpoint was complete response (CR: no emesis/no rescue medication) during the overall phase (0-120 h) across three consecutive cycles. - Results - Of 401 randomly allocated patients, 388 were included in the efficacy analysis. The most common cancers were colorectal and lung; oxaliplatin and carboplatin were the most common MECs. Patients randomly assigned to NEPA were significantly more likely to experience a CR compared with SOC (odds ratio 1.67, 95% confidence interval 1.12-2.49, P = 0.012). The NEPA group had a significantly higher probability of CR, no nausea, no emesis, and complete protection (81.0%, 63.7%, 95.4%, and 71.8%, respectively) compared with the SOC arm (71.8%, 54.9%, 86.7%, and 62.4%, respectively) across three cycles of chemotherapy. - Conclusions - When individual risk factors are considered before MEC, a three-drug regimen including NEPA provides superior CINV prevention across multiple cycles compared with the standard two-drug approach. These findings underscore the value of personalised risk-adapted antiemetic strategies and have practice-changing potential for optimising antiemetic control. |
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| Description: | Gesehen am 05.06.2026 |
| Description matérielle: | Online Resource |
| ISSN: | 1569-8041 |
| DOI: | 10.1016/j.annonc.2025.10.017 |