Chemotherapy often causes nausea and vomiting (CINV), and this is a major problem for the children being treated for cancer. To prevent this, a combination of two substances in fixed proportion (IV NEPA) was developed. The two substances are: palonosetron, an antagonist of 5 HT3 receptors, and fosnetupitant, an antagonist of NK1 receptors that transforms into netupitant in the body. The medication is administered through intravenous injection (IV- drip). This study is built from 2 parts: Part 1: phase 2, open label Part 2: phase 3 double blind The detailed description, study design, study milestones and eligibility criteria will reflect the Part 1 requirements
Part I of the study is a Phase 2, open-label, randomised (for Cohort 1 only), single chemotherapy cycle study which will compare single-dose of IV NEPA to another treatment (fosaprepitant/ondansetron) considered as a standard of care, in patients receiving single-day chemotherapy that has a high possibility to generate a vomiting episode (HEC) (Cohort 1) and assess repeated dose of IV NEPA in patients receiving multi day HEC chemotherapy (Cohort 2). Because this will be the first study testing the IV NEPA in children, Part I will enroll patients from older to younger age groups with safety checks before moving to the next group.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
PREVENTION
Masking
NONE
Enrollment
95
In NEPA-22-01, different body weight-based dosages of IV NEPA will be applied to patients below and over 3 months of age: Formulation A (for patients ≥3 months of age; 235 mg fosnetupitant/1.5 mg palonosetron per vial) or Formulation B (for patients \<3 months of age; 235 mg fosnetupitant/2.5 mg palonosetron per vial).
IV Ondansetron Dosing Regimen * Day 1 (before start of chemotherapy): One 30-min infusion of 0.15 mg/kg (ondansetron maximum dose: 8 mg per administration) * Day 1 at 4 h and 8 h after the end of first administration: Two 30-min infusions of 0.15 mg/kg (ondansetron maximum dose: 8 mg per administration)
Fosaprepitant IV Dosing Regimen * Patients aged 12 years to \<18 years: a single dose of IV fosaprepitant 150 mg * Patients aged 2 years to \<12 years: a single dose of IV fosaprepitant 4 mg/kg (maximum dose: 150 mg) * Patients aged 6 months to \<2 years: a single dose of IV fosaprepitant 5 mg/kg (maximum dose: 150 mg)
Aghia Sophia Children's Hospital, Pediatric Hematology/ Oncology Unit (POHemU)
Athens, Greece
NOT_YET_RECRUITING"AHEPA" University General Hospital of Thessaloniki, 2nd Department of Pediatrics
Thessaloniki, Greece
NOT_YET_RECRUITINGDepartment of Pediatrics, Oncology and Hematology University Children's Clinical Hospital them. Ludwik Zamenhof in Bialystok
Bialystok, Poland
RECRUITINGClinic of Pediatrics, Oncology and Hematology University Pediatric Center them M. Konopnicka SP ZOZ Central Clinical Hospital Medical University of Lodz
Lodz, Poland
COHORT 1 Neptupitant exposure parameter
Maximum concentration (Cmax)
Time frame: From time zero ( start of IV NEPA infusion) to maximum 168 hours
COHORT 1 Neptupitant exposure
Area under the plasma concentration-time curve
Time frame: From time zero ( start of IV NEPA infusion) to maximum 168 hours
COHORT 2 monitoring of AEs (safety and tolerability of IV NEPA)
monitoring of AEs following repeated IV NEPA administration
Time frame: Up to 31 days
COHORT 1: To assess the PK profile of netupitant.
Cmax of netupitant
Time frame: From Time zero ( start of IV NEPA infusion) until 168 hours
COHORT 1: To assess the PK profile of fosnetupitant.
Cmax of fosnetupitant
Time frame: From Time zero ( start of IV NEPA infusion) until 168 hours
COHORT 1: To assess the PK profile palonosetron.
Cmax of palonosetron
Time frame: From Time zero ( start of IV NEPA infusion) until 168 hours
COHORT 1: To assess the PK profile of netupitant
AUC0-48 of netupitant
Time frame: From Time zero ( start of IV NEPA infusion) until 48 hours
COHORT 1: To assess the PK profile of fosnetupitant.
AUC0-48 of fosnetupitant
Time frame: From Time zero ( start of IV NEPA infusion) until 48 hours
COHORT 1: To assess the PK profile palonosetron.
AUC0-48 of palonosetron
Time frame: From Time zero ( start of IV NEPA infusion) until 48 hours
COHORT 1: To assess the PK profile of netupitant
t1/2 of netupitant
Time frame: From Time zero ( start of IV NEPA infusion) until 168 hours
COHORT 1: To assess the PK profile of palonosetron.
t1/2 of palonosetron
Time frame: From Time zero ( start of IV NEPA infusion) until 168 hours
COHORT 1 and 2: To assess the population PK profile of fosnetupitant.
Clearance (CL) of fosnetupitant
Time frame: From Time zero ( start of IV NEPA infusion) until 168 hours
COHORT 1 and 2: To assess the population PK profile of palonosetron.
CL of palonosetron
Time frame: From Time zero ( start of IV NEPA infusion) until 168 hours
COHORT 1 and 2: To assess the population PK profile of netupitant.
CL/F of netupitant
Time frame: From Time zero ( start of IV NEPA infusion) until 168 hours
COHORT 1 and 2: To assess the population PK profile of fosnetupitant
Volume of compartments (V) for fosnetupitant
Time frame: From Time zero ( start of IV NEPA infusion) until 168 hours
COHORT 1 and 2: To assess the population PK profile of palonosetron.
V for palonosetron
Time frame: From Time zero ( start of IV NEPA infusion) until 168 hours
COHORT 1 and 2: To assess the population PK profile of netupitant.
V/F for netupitant
Time frame: From Time zero ( start of IV NEPA infusion) until 168 hours
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Clinical Department of Paediatric Oncology and Haematology VOIVODSHIP SPECIALIST CHILDREN'S HOSPITAL them. prof. dr. Stanisław Popowski in Olsztyn
Olsztyn, Poland
NOT_YET_RECRUITINGDepartment of Pediatric Oncology, Hematology and Transplantation Clinical Hospital them. Karol Jonscher Medical University them. Karol Marcinkowski in Poznań
Poznan, Poland
RECRUITINGDepartment of Paediatrics and Paediatric Haemato-Oncology University Clinical Hospital No. 1 them. prof. Tadeusz Sokołowski Pomeranian Medical University
Szczecin, Poland
NOT_YET_RECRUITINGDepartment of Paediatrics, Oncology and Paediatric Immunology, University Clinical Hospital No. 1 them. prof. Tadeusz Sokołowski Pomeranian Medical University in Szczecin
Szczecin, Poland
RECRUITINGDepartment of Oncology and Surgical Oncology for Children and Youth Institute Mother and Child
Warsaw, Poland
RECRUITINGDepartment of Oncology Institute "Monument - Child Health Center"
Warsaw, Poland
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