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.