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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 is 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

An NK-1 RA in combination with a 5-HT3 RA and dexamethasone is recommended for patients receiving HEC

MEC - moderately emetogenic chemotherapy

Adding an NK-1 RA to a 5-HT3 RA and dexamethasone is recommended for patients receiving MEC 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

  • Anaphylaxis, anaphylactic shock and other serious hypersensitivity reactions have been reported with VARUBI IV, most often immediately following initiation of infusion. If symptoms occur, stop the infusion, initiate appropriate medical management, and permanently discontinue VARUBI IV.

  • 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
  • AC combination*
  • Carboplatin AUC ≥4
  • Carmustine >250 mg/m2
  • Cisplatin
  • Cyclophosphamide >1,500 mg/m2
  • Dacarbazine
  • Doxorubicin ≥60 mg/m2
  • Epirubicin >90 mg/m2
  • lfosfamide ≥2 g/m2 per dose
  • Mechlorethamine
  • Streptozocin
*Any chemotherapy regimen that contains an anthracycline and cyclophophamide
Common HEC regimens
  • ABVD
  • AC
  • BEACOPP
  • CAF
  • CHOP
  • C-MOPP
  • Carbo-docetaxel
  • Carboplatin/paclitaxel/bevacizumab (PCB)
  • Carbo-tax
  • CEF
  • Cisplatin/docetaxel or cisplati/paclitaxel
  • Cisplatin/etoposide
  • Cisplatin/pemetrexed
  • CMF
  • Epirubicin/cyclophosphamide (EC)
  • Etoposide/carboplatin
  • Gemcitabine/carboplatin
  • Gemcitabine/cisplatin
  • Intraperitoneal cisplatin/docetaxel or cisplatin/paclitaxel
  • R-EPOCH
  • Stanford V
  • TAC
  • TCH
  • Vinorelbine/cisplatin
Common MEC regimens
  • CapeOX
  • CVP
  • Docetaxel/Cyclophosphamide (TC)
  • FOLFIRI
  • FOLFOX
  • FOLFOXIRI
  • IROX
Common MEC agents
  • Aldesleukin >12-15 million IU/m2
  • Amifostine >300 mg/m2
  • Arsenic trioxide
  • Azacitidine
  • Bendamustine
  • Busulfan
  • Carboplatin* AUC <4
  • Carmustine* ≤250 mg/m2
  • Clofarabine
  • Cyclophosphamide ≤1,500 mg/m2
  • Cytarabine >200 mg/m2
  • Dactinomycin*
  • Daunorubicin*
  • Dinutuximab
  • Doxorubicin* <60 mg/m2
  • Epirubicin* ≤90 mg/m2
  • Idarubicin
  • Ifosfamide* <2 g/m2 per dose
  • Interferon alfa ≥10 million IU/m2
  • Irinotecan*
  • Melphalan
  • Methotrexate* ≥250 mg/m2
  • Oxaliplatin
  • Temozolomide
  • Trabectedin*
*May be highly emetogenic for certain patients.

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.