Antiemetic guidelines recommend proactive protection

The National Comprehensive Cancer Network® (NCCN), American Society of Clinical Oncology (ASCO), and Multinational Association of Supportive Care in Cancer (MASCC) guidelines all recommend prevention from chemotherapy-induced nausea and vomiting (CINV) rather than reactive treatment for breakthrough emesis.1-3

 

Rolapitant now included as a category 1 neurokinin 1 receptor antagonist (NK-1 RA) for both highly and moderately emetogenic chemotherapy (HEC and MEC) in the National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Antiemesis

Category 1: based on high-level evidence and uniform NCCN consensus1

HEC guidelines mobile - HEC guidelines

Several options including a 5-hydroxytryptamine-3 (serotonin) (5-HT3) RA, dexamethasone, and an NK-1 RA

MEC guidelines mobile - MEC guidelines

Several options including a 5-HT3 RA and dexamethasone; NK-1 RA for patients who failed antiemetic treatment in a previous chemotherapy cycle or if patients have risk factors that increase the likelihood of getting CINV

Drug interactions

 

Select tumor type to see the emetogenic potential of common regimens

Select tumor type
Acute lymphoblastic leukemia
Acute myeloid leukemia
Bladder
Brain
Breast
Colorectal
Esophageal
Hodgkin lymphoma
Lung
Multiple myeloma
Non-Hodgkin’s lymphoma
Ovarian
Pancreatic
Adapted from NCCN Guidelines®.
Adapted from NCCN Guidelines®.
 

See the emetogenic potential of common chemotherapy regimens and agents   

Common HEC agents
  • Carmustine >250 mg/m2
  • Cisplatin
  • Cyclophosphamide >1,500 mg/m2
  • Dacarbazine
  • Doxorubicin ≥60 mg/m2
  • Epirubicin >90 mg/m2
  • Ifosfamide ≥2 g/m2 per dose
  • Mechlorethamine
  • Streptozocin
Common MEC agents
  • Aldesleukin >12-15 million IU/m2
  • Amifostine >300 mg/m2
  • Arsenic trioxide
  • Azacitidine
  • Bendamustine
  • Busulfan
  • Carboplatina
  • Carmustinea ≤250 mg/m2
  • Clofarabine
  • Cyclophosphamide ≤1,500 mg/m2
  • Cytarabine >200 mg/m2
  • Dactinomycina
  • Daunorubicina
  • Doxorubicina <60 mg/m2
  • Epirubicina ≤90 mg/m2
  • Idarubicin
  • Ifosfamidea <2 g/m2 per dose
  • Interferon alfa ≥10 million IU/m2
  • Irinotecana
  • Lomustine
  • Melphalan
  • Methotrexatea ≥250 mg/m2
  • Oxaliplatin
  • Temozolomide
a May be highly emetogenic for certain patients.
Common HEC regimens
  • ABVD
  • AC
  • BEACOPP
  • CAF
  • Cisplatin/pemetrexed
  • CT/C-P
  • Gemcitabine/cisplatin
  • Intraperitoneal CT
  • TAC
  • Vinorelbine/cisplatin
Common MEC regimens
  • CapeOX
  • Carbo-docetaxel
  • Carbo-tx
  • CEF
  • CHOP
  • CMF
  • CVP
  • EC
  • FOLFIRI
  • FOLFOX
  • FOLFOXIRI
  • GC
  • Irinotecan
  • IROX
  • PCB
  • R-EPOCH
  • Stanford V
  • TC
  • TCH
 
 
 

Indication and Important Safety Information for VARUBI® (rolapitant)

Indication

  • VARUBI, in combination with other antiemetic agents, is indicated in adults for the prevention of delayed nausea and vomiting associated with initial and repeat courses of emetogenic cancer chemotherapy, including, but not limited to, highly emetogenic chemotherapy

Contraindication

  • VARUBI is contraindicated in patients receiving thioridazine, a CYP2D6 substrate. A significant increase in plasma concentrations of thioridazine may result in QT prolongation and Torsades de Pointes

Warnings and precautions

Interaction with CYP2D6 substrates with a narrow therapeutic index

  • The inhibitory effect of VARUBI on CYP2D6 lasts for at least 7 days and may last longer after administration of a single dose of VARUBI
  • Avoid use of VARUBI in patients who are receiving pimozide, a CYP2D6 substrate. An increase in plasma concentrations of pimozide may result in QT prolongation
  • Monitor for adverse reactions if concomitant use of VARUBI and other CYP2D6 substrates with a narrow therapeutic index cannot be avoided

Adverse reactions

  • In patients receiving cisplatin-based highly emetogenic chemotherapy in cycle 1, the most common adverse reactions reported at an incidence of ≥5% and a frequency greater than control were neutropenia (9% VARUBI vs 8% control) and hiccups (5% vs 4%)
  • In patients receiving moderately emetogenic chemotherapy and combinations of anthracycline and cyclophosphamide in cycle 1, the most common adverse reactions reported at an incidence of ≥5% and a frequency greater than control were decreased appetite (9% VARUBI vs 7% control), neutropenia (7% vs 6%), and dizziness (6% vs 4%)

Drug interactions

  • VARUBI is an inhibitor of breast cancer resistance protein (BCRP) and P-glycoprotein (P-gp). Increased plasma concentrations of BCRP and P-gp substrates with a narrow therapeutic index may result in potential adverse reactions. Monitor for adverse reactions related to the concomitant drug if use with VARUBI cannot be avoided
  • Avoid use of VARUBI in patients who require chronic administration of strong CYP3A4 inducers (eg, rifampin) as significantly reduced plasma concentrations of VARUBI can decrease the efficacy of VARUBI
 

Please see full Prescribing Information.

 
 

References: 1. Referenced with permission from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Antiemesis v.2.2015. © National Comprehensive Cancer Network, Inc., 2015. All rights reserved. Accessed October 13, 2015. To view the most recent and complete version of the guideline, go online to NCCN.org. NATIONAL COMPREHENSIVE CANCER NETWORK®, NCCN®, NCCN GUIDELINES®, and all other NCCN Content are trademarks owned by the National Comprehensive Cancer Network, Inc. 2. Basch E, Prestrud AA, Hesketh PJ, et al. Antiemetics: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol. 2011;29(31):4189-4198. 3. Roila F, Herrstedt J, Aapro M, et al; on behalf of ESMO/MASCC Guidelines Working Group. Guideline update for MASCC and ESMO in the prevention of chemotherapy- and radiotherapy-induced nausea and vomiting: results of the Perugia consensus conference. Ann Oncol. 2010;21(suppl 5):v232-v243.

 
 
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Indication and Important Safety Information for VARUBI® (rolapitant)   button arrow