| Sumario: | Netupitant/palonosetron (Akynzeo) is an oral fixed-dose combination of netupitant, a neurokinin-1 (NK1) receptor antagonist (RA), and palonosetron, a 5-hydroxytryptamine-3 (5-HT3) RA, available as a 300 mg/0.5 mg oral capsule. In combination with dexamethasone, netupitant/palonosetron (NEPA) is indicated for once-per-cycle treatment in adult patients for: 1. prevention of acute and delayed nausea and vomiting associated with highly emetogenic (HEC) chemotherapy, 2. prevention of acute nausea and vomiting associated with moderately emetogenic (MEC) therapy that is uncontrolled by a 5-HT3 receptor antagonist alone. Oral palonosetron was previously reviewed by CADTH Common Drug Review (CDR) in 2013 and received a "do not list" recommendation based on clinical reasons, notably the absence of direct or indirect comparisons of oral palonosetron with other oral 5-HT3RAs for the treatment of chemotherapy-induced nausea and vomiting (CINV), and because "oral palonosetron failed to demonstrate non-inferiority against intravenous palonosetron" in the delayed phase. The recommended dose for NEPA is one capsule administered orally 1 hour prior to the start of a chemotherapy cycle. The manufacturer is seeking reimbursement in line with the Health Canada indication. The manufacturer submitted a price of $135 per capsule; therefore, the cost of NEPA is $135 per chemotherapy cycle.
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