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

HEC - highly emetogenic chemotherapy

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

MEC - moderately emetogenic chemotherapy

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

Warnings and Precautions

Interaction with CYP2D6 substrate

  • VARUBI is a moderate inhibitor of CYP2D6 and significantly increases the plasma concentrations of CYP2D6 substrates for at least 28 days, with inhibitory effects expected to persist for an unknown duration.

  • Monitor for adverse reactions when VARUBI is coadministered with CYP2D6 substrates without a narrow therapeutic index (avoid coadministration with CYP2D6 substrates with a narrow therapeutic index, thioridazine and pimozide; see Contraindication).  Consider interactions with CYP2D6 substrates before starting treatment with 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
Bladder
Brain
Breast
Colorectal
Esophageal
Hodgkin lymphoma
Lung
Multiple myeloma
Non-Hodgkin’s lymphoma
Ovarian
Pancreatic
Adapted from NCCN Guidelines®.
Interactive image to select a tumor type to see emetogenic potential of common regimens Interactive image to select a tumor type to see emetogenic potential of common regimens Interactive image to select a tumor type to see emetogenic potential of common regimens Interactive image to select a tumor type to see emetogenic potential of common regimens Interactive image to select a tumor type to see emetogenic potential of common regimens Interactive image to select a tumor type to see emetogenic potential of common regimens Interactive image to select a tumor type to see emetogenic potential of common regimens Interactive image to select a tumor type to see emetogenic potential of common regimens Interactive image to select a tumor type to see emetogenic potential of common regimens Interactive image to select a tumor type to see emetogenic potential of common regimens Interactive image to select a tumor type to see emetogenic potential of common regimens Interactive image to select a tumor type to see emetogenic potential of common regimens Interactive image to select a tumor type to see emetogenic potential of common regimens Interactive image to select a tumor type to see emetogenic potential of common regimens
Interactive image to select a tumor type to see emetogenic potential of common regimens Interactive image to select a tumor type to see emetogenic potential of common regimens Interactive image to select a tumor type to see emetogenic potential of common regimens Interactive image to select a tumor type to see emetogenic potential of common regimens Interactive image to select a tumor type to see emetogenic potential of common regimens Interactive image to select a tumor type to see emetogenic potential of common regimens Interactive image to select a tumor type to see emetogenic potential of common regimens Interactive image to select a tumor type to see emetogenic potential of common regimens Interactive image to select a tumor type to see emetogenic potential of common regimens Interactive image to select a tumor type to see emetogenic potential of common regimens Interactive image to select a tumor type to see emetogenic potential of common regimens Interactive image to select a tumor type to see emetogenic potential of common regimens Interactive image to select a tumor type to see emetogenic potential of common regimens Interactive image to select a tumor type to see emetogenic potential of common regimens Interactive image to select a tumor type to see emetogenic potential of common regimens Interactive image to select a tumor type to see emetogenic potential of common regimens Interactive image to select a tumor type to see emetogenic potential of common regimens Interactive image to select a tumor type to see emetogenic potential of common regimens Interactive image to select a tumor type to see emetogenic potential of common regimens Interactive image to select a tumor type to see emetogenic potential of common regimens Interactive image to select a tumor type to see emetogenic potential of common regimens
Interactive image to select a tumor type to see emetogenic potential of common regimens Interactive image to select a tumor type to see emetogenic potential of common regimens
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