Akynzeo approved for CINV

Christine A. Zawistowski, MD

Chemotherapy is the most common treatment-related cause of nausea and vomiting for patients with cancer. For patients, it also is the most feared effect of chemotherapy. The adverse consequences of chemotherapy-induced nausea and vomiting (CINV) are many, including metabolic derangements, nutritional deficiencies, esophageal tears, wound dehiscence, deterioration of performance and mental status, and degeneration of self-care and functional status. It may lead to the discontinuation of potentially beneficial or curative anticancer treatments, and it significantly affects quality of life.
Although the incidence and severity varies according to many factors, studies have shown that the number of patients suffering from this side effect is not insignificant. For patients who receive moderately and highly emetogenic chemotherapy, the incidence of acute nausea was 35% and acute emesis was 13%. These rates increased to 60% for delayed nausea and 50% for delayed emesis in those who received highly emetogenic chemotherapy. Among those who received moderately emetogenic chemotherapy, 52% experienced delayed nausea and 28% experienced delayed emesis.
Evidence-based clinical practice guidelines exist for CINV, and guideline conformity improves CINV control for patients, but guideline adherence is suboptimal. Divergence from the guidelines takes many forms — under-dosing medications, over-dosing medications and prescribing the wrong combination of medications for the emetic risk of the chemotherapeutic agent — and the reasons for this are unclear.
Akynzeo is a fixed-combination capsule containing two medications that are currently in use for CINV and are part of the three-drug regimen recommended for patients receiving highly emetic chemotherapy. It has been shown to be superior to other medications for the overall and delayed phases of CINV — which often can be more common and severe than the acute phase — and it also controls nausea better than other medications currently being used. This medication provides the opportunity to overcome some of the barriers interfering with guideline adherence by targeting two pathways involved in emesis with a single oral dose of medicine.
Akynzeo will provide ease of prescribing the appropriate medications at the appropriate doses, works effectively for the overall phase of CINV and controls nausea. This is the most feared side effect of chemotherapy for patients, and it significantly affects quality of life and compliance with future treatments. This medication has the potential to improve adherence to the guidelines and significantly improve quality of life for patients who receive chemotherapy.