Abstract:
Most patients receiving highly or moderately emetogenic chemotherapy experience
chemotherapy-induced
nausea and vomiting without antiemetic prophylaxis. While
neurokinin-1
receptor antagonists (NK-1RAs)
effectively prevent emesis, their ability
to prevent nausea has not been established. We evaluated the efficacy of the long-acting
NK-1RA
rolapitant in preventing chemotherapy-induced
nausea using post
hoc analyses of data from 3 phase 3 trials. Patients were randomized to receive
180 mg oral rolapitant or placebo approximately 1-2
hours before chemotherapy in
combination with a 5-hydroxytryptamine
type 3 RA and dexamethasone. Nausea
was assessed by visual analog scale during the acute (≤24 hours), delayed (>24-120
hours), and overall (0-120
hours) phases. Post hoc analyses by treatment group
(rolapitant vs control) were performed on pooled data within patient subgroups receiving
cisplatin-based,
carboplatin-based,
or anthracycline/cyclophosphamide
(AC)-based
chemotherapy. In the cisplatin-based
chemotherapy group, significantly
more patients receiving rolapitant than control reported no nausea (NN) in the overall
(52.3% vs 41.7% [P < .001]; absolute benefit [AB] = 10.6%), delayed (55.7% vs
44.3% [P < .001]; AB = 11.4%), and acute (70.5% vs 64.3% [P = .030]; AB = 6.2%)
phases. Similar results were observed in the carboplatin-based
chemotherapy group,
with significantly more patients receiving rolapitant than control reporting NN in the
overall (62.5% vs 51.2% [P = .023]; AB = 11.3%) and delayed (64.1% vs 53.6%
[P = .034]; AB = 10.5%) phases. In the AC-based
chemotherapy group, patients receiving
rolapitant or control reported similar NN rates during the overall and delayed phases. Rolapitant effectively prevents nausea during the overall and delayed phases
in patients receiving cisplatin-or
carboplatin-based
chemotherapy.
