Drug Helps Prevent Chemo-Induced Nausea/Vomiting

The drug rolapitant given in combination with granisetron/dexamethasone more effectively prevented chemotherapy-induced nausea and vomiting than granisetron/dexamethasone alone in patients undergoing treatment with cisplatin-based chemotherapy, results of a new study show (Abstract LBA47_PR).

Rolapitant is a novel antagonist of the NK-1 receptor. Patients treated with rolapitant had significant improvements in nausea and vomiting without affecting other quality-of-life indicators.

Details about the new drug were discussed by Martin Chasen, MD, lead author and medical director, Palliative Care, Ottawa Hospital Cancer Centre, Canada, in a press release from the ESMO 2014 Congress.

Prior phase II and III trials had shown that rolapitant could safely and effectively prevent chemotherapy-induced nausea and vomiting. This phase III multicenter trial randomly assigned 532 patients receiving cisplatin-based chemotherapy to receive oral rolapitant plus granisetron/dexamethasone or placebo plus granisetron/dexamethasone. The researchers examined complete response, defined as no emesis or rescue medications, in the delayed phase post-chemotherapy.

Patients assigned rolapitant had significantly higher rates of complete response compared with patients given granisetron/dexamethasone alone (72.7% vs 58.4%; P < .001). These improvements were observed in both the acute phase (0-24 hours: 83.7% vs 73.7%; P = .005) and overall (0-120 hours: 70.1% vs 56.5%; P = .001).

Commenting on the results, Chasen said, “We know that the NK-1 receptor in the brain must be blocked to control nausea and vomiting-there are other agents that block this for a short time; rolapitant is an exceptionally long term receptor blocker that binds to the receptor and remains in place for up to 120 hours, therefore not allowing the chemotherapy to induce nausea and vomiting.”

The researchers also conducted a regional complete response analysis comparing outcomes in North America, Asia/South Africa, Europe, and Central/South America. The improvements in complete response rates with rolapitant were seen across all of the geographic regions examined.

Additionally, a higher percentage of patients assigned rolapitant reported no effect on their daily quality of life compared with granisetron/dexamethasone alone (72.8% vs 67.8%; P = .231); however, the difference was not statistically significant.

Chasen and colleagues examined rolapitant in cisplatin, considered to be one of the stronger inducers of emesis; however, they said that the drug could also be evaluated in less emetogenic cancer treatments.