Prophylaxis for Emetogenic radioTherapy With Akynzeo

• Age ≥18 years old
• Consent/registration on PERa study and selected for PRÊT study
• Patients with a full list of analgesic and anti-nauseant medications used
• Patients with the ability to complete the quality-of-life questionnaires
• KPS ≥40
• Patients who have planned for radiotherapy in PMCC to at least symptomatic site located in the body trunk between T10-Pelvis anatomical landmarks or if the stomach is within the field borders
• No planned changes in analgesic within 5 days before and after treatment
• No planned cytotoxic chemotherapy, radiotherapy or surgery within 5 days before and 7 days after radiotherapy initiation. Oral molecularly targeted agents and immunotherapy are allowed to be continued without interruption or delay.
• Able to swallow pills
• The patient provided informed consent to participate in this study

Exclusion Criteria:

• Patients with major mental or psychiatric impairments
• Patients receiving brain radiation within 7 days of study intervention
• Pregnant or breastfeeding (up to one month after the last dose) females.
• Patients using CYP3A4 inducers within 4 weeks of Akynzeo treatment: Carbamazepine, Phenobarbital, Phenytoin, St. John's wort, Rifampicin, and Pioglitazone
• Patients using CYP3A4 substrates concurrently with Akynzeo: pimozide, terfenadine, astemizole, or cisapride
• Patients with hypersensitivity to netupitant/palonosetron drugs or to any ingredient in the formulation or component of the container.
• Patients who have or likely to develop prolongation of the QT interval. Risk factors include, but are not limited to, a personal or family history of QT prolongation (e.g., congenital long QT syndromes), electrolyte abnormalities or conditions that can lead to electrolyte abnormalities (e.g., eating disorders), cardiac disease (e.g., congestive heart failure, myocardial ischemia, conduction system disease), and bradycardia or bradyarrhythmia. Caution should also be observed in patients taking anti-arrhythmic medicinal products, other medicinal products that lead to QT prolongation or electrolyte abnormalities, or drugs that inhibit the metabolism of netupitant or palonosetron. Hypokalemia, hypocalcemia, and hypomagnesemia should be corrected prior to administration.
• Patients with suspected or known severe hepatic impairment (Child-Pugh Score >9) and patients with a bilirubin >51.3 µmol/L, albumin \<28 g/L and INR >2.3 from blood works done within 90 days.
• Patients with suspected or known severe renal impairment (creatine clearance \<30 mL/min per bloodwork done within 90 days), end-stage renal disease or on dialysis.