Review of oral fixed-dose combination netupitant and palonosetron (NEPA) for the treatment of chemotherapy-induced nausea and vomiting

Current guidelines recommend the combination of a neurokinin-1 (NK₁) receptor antagonist (RA) and a 5-hydroxytryptamine-3 (5-HT₃) RA, together with corticosteroids, in order to prevent chemotherapy-induced nausea and vomiting with anthracycline–cyclophosphamide and highly emetogenic chemotherapy, and it is to be considered with moderately emetogenic chemotherapy. Netupitant and palonosetron (NEPA) is a fixed-dose combination of netupitant, a novel, highly selective NK₁ RA, and palonosetron, a new-generation 5-HT₃ RA, targeting two major emetic pathways in a single oral capsule.