For US health-care professionals only. Prescribing Information

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

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

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

  • VARUBI® (rolapitant) 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

Select tumor type to see the emetogenic potential of common regimens

Adapted from NCCN Guidelines®.

Select tumor type
Acute lymphoblastic leukemia
Acute myeloid leukemia
Hodgkin lymphoma
Multiple myeloma
Non-Hodgkin’s lymphoma
Adapted from NCCN Guidelines®.
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
  • 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
  • GC
  • Irinotecan
  • IROX
  • PCB
  • Stanford V
  • TC
  • TCH