Abstract P034

Netupitant/palonosetron for prevention of chemotherapy-induced nausea and vomiting in Hodgkin lymphoma treated with ABVD or BV-AVD: a single-centre observational study

Background: ABVD and brentuximab vedotin-AVD (BV-AVD) represent the standard-of-care therapeutic regimens for the treatment of classical Hodgkin lymphoma (HL) and require effective prophylaxis against chemotherapy-induced nausea and vomiting (CINV). Fixed-dose oral netupitant/palonosetron (NEPA) combines an NK1 receptor antagonist and a second-generation 5-HT3 receptor antagonist, but HL-specific data remain limited. We evaluated the effectiveness of NEPA-based prophylaxis in patients receiving first-line ABVD or BV-AVD.

Methods: We performed a retrospective single-centre observational study including patients with HL treated at the University Hospital of Padova between 2021 and 2024. Patients who escalated to BEACOPP or salvage therapy after interim PET were excluded to assess CINV outcomes across ABVD/BV-AVD treatment. NEPA was administered with or without dexamethasone according to physician choice. The primary endpoint was complete response (CR), defined as no emesis and no rescue antiemetic use, during the overall phase from 0–120 hours after chemotherapy. Secondary endpoints were acute CR (0–24 hours), delayed CR (24–120 hours) and complete control (CR with no more than mild nausea).

Results: One hundred patients were included; 54% were female and median age was 33 years. Seventy-one patients received ABVD and 29 received BV-AVD, for a total of 1040 chemotherapy administrations evaluable for CINV. NEPA plus dexamethasone was used in 73 patients and NEPA alone in 27. Acute-phase control was high, with acute CR in 97 [95%CI 91-99] patients. The 3 subjects who did not obtain acute CR also experienced acute vomiting. Overall-phase CR was 72% (95%CI 62-80), while complete control was achieved in 61% (95%CI 51-71). Delayed nausea occurred in 34% (95%CI 25-44), was predominantly mild-to-moderate in severity, and was not accompanied by vomiting. Rescue antiemetics were required in 26 (95%CI 18-36). Delayed CINV occurred mainly during the first cycle, accounting for 25/34 (73%; 95%CI 56-87) of delayed events, with no recurrence of the symptoms being reported in all but 2 subjects.

Conclusion: In this single-centre HL cohort, NEPA-based prophylaxis provided high acute-phase protection and low rates of vomiting during ABVD and BV-AVD. Delayed nausea remained the main residual unmet need. These findings support NEPA as a feasible antiemetic strategy in this setting and justify prospective evaluation of risk-adapted prophylaxis.