e-Poster Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2020

Addition of netupitant to 5HT3-receptor antagonist/dexamethasone prophylaxis with FOLFOX reduces rates of chemotherapy-induced nausea and vomiting (CINV).  (#380)

Eunice Dai 1 , Stephen Della-Fiorentina 2 , Mina Toumas 1 , Tognela Annette 2 , Stephanie Lim 2 , Aflah Roohullah 1 2
  1. Liverpool Cancer Therapy Centre, Liverpool, NSW, Australia
  2. Macarthur Cancer Therapy Centre, Campbelltown, NSW, Australia


One of the biggest treatment-related fears surrounding chemotherapy is nausea and vomiting.  A previous departmental audit revealed the incidence of chemotherapy-induced nausea and vomiting (CINV) during fluorouracil-leucovorin-oxaliplatin (FOLFOX) treatment with 5HT3-antagonist/dexamethasone pre-medication was 90.1%. 


The primary aim was to assess the incidence of breakthrough-CINV in patients receiving triple-therapy prophylaxis (with netupitant/dexamethasone/palonosetron) versus historical control data in those-receiving 5HT3-dexamethasone prophylaxis with FOLFOX chemotherapy.


A single-centre retrospective analysis was performed, comparing the rates of breakthrough-CINV with triple-therapy prophylaxis versus historical control data in those receiving 5HT3-dexamethasone prophylaxis with FOLFOX.  Patient data, treatment details and outcomes were extracted using Mosaiq®, an institutional electronic database. 

Significance of the association between two categorial variables was assessed by Fisher’s exact test, with P-values being two-sided and levels of significance defined as P < 0.05.   Statistical analysis was performed using SPSS software.  


  • A total of 45 patients underwent triple therapy between March 2018 – January 2019, and 107 patients received 5-HT3-dexamethasone with FOLFOX between January 2016 – March 2018.
  • There was reduced incidence of vomiting with triple-therapy with 4 patients (6.15%) compared to 32 patients (21.77%) on 5HT3-dexamethasone, p = 0.005.  Time to maximum vomiting occurred later, at a median cycle 4.5 with triple therapy compared to cycle 3 with 5HT3-dexamethasone.   Type 3 effect test was 0.04.
  • There was reduced incidence of nausea in the triple-therapy group, with 44 patients (67.69%) experiencing vomiting compared to 135 patients (91.84%) in the 5HT3-dexamethasone group, p = 0.0001. Time to maximum nausea occurred later, at a median cycle 3 with triple therapy compared to cycle 2 with 5HT3-dexamethasone.  Type 3 effect test was 0.0118.


  • With upfront triple-therapy prophylaxis, there was a statistically significant reduction in both nausea and vomiting. Triple-therapy prophylaxis with netupitant-palonosetron-dexamethasone should be considered for patients receiving FOLFOX chemotherapy, where there are no major contraindications.
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  2. Sun C., Bodurka D., et al. Rankings and symptom assessments of side effects from chemotherapy: insights from experienced patients with ovarian cancer. Support Care Cancer. 2005 Apr; 13(4):219-27.
  3. U.S. Department of Health and Human Services. Common Terminology Criteria for Adverse Events (CTCAE) Version 4.0, 14 June, 2010.