Rolapitant, a selective and long-acting neurokinin-1 (NK-1) receptor antagonist, may provide adult cancer patients with significant benefits beyond those of previously approved NK-1 receptor antagonists, according to Bernardo Leon Rapoport, MD, who is with The Medical Oncology Centre of Rosebank in Johannesburg, South Africa. He is the author of a review article published in Cancer Management and Research that suggests this agent can help combat delayed chemotherapy-induced nausea and vomiting (CINV), improve quality of life, and provide other benefits for patients.
CINV commonly occurs during the acute phase (24 hours after chemotherapy administration) and during the delayed phase (5-day at-risk period). However, patients often are not in direct contact with their oncology care team during the delayed phase, and this where significant improvement is needed in the clinical management of these patients, according to the review.
NK-1 receptor antagonists can help prevent acute and delayed CINV in patients treated with highly emetogenic chemotherapy (HEC) and moderately emetogenic chemotherapy (MEC). These agents are used in combination with a 5-hydroxytryptamine 3 receptor antagonist and dexamethasone. Dr Rapoport examined the differential pharmacology and clinical utility of rolapitant in preventing CINV compared with other NK-1 receptor antagonists.
Rolapitant was granted approval for the management of delayed CINV by the US Food and Drug Administration (FDA) in September 2015. In a phase 3 trial, rolapitant 180 mg demonstrated statistical superiority compared with active control (5-HT3 receptor antagonist plus dexamethasone) in the delayed phase of CINV. The trial involved 1332 patients receiving moderately emetogenic chemotherapy regimens, including anthracycline/cyclophosphamide combinations, carboplatin, irinotecan, pemetrexed, oxaliplatin, and doxorubicin.