Rolapitant

Abstract: Despite considerable progress in the management of chemotherapy-associated nausea and vomiting, these symptoms remain among the most feared by patients beginning cytotoxic chemotherapy. 5-HT3 antagonists have decreased the frequency of postchemotherapy vomiting. However, emesis remains a problem for a significant minority of patients. In addition, nausea continues to be a formidable challenge despite the better control of vomiting with current treatment options [1]. The relative likelihood of significant emesis in a given individual is dependent upon both patient- and treatment-related factors. Patient factors with predictive value for decreased emesis include heavy alcohol consumption and male sex [2]. A number of other factors including younger age [3], poor performance status [3], severe emesis during pregnancy [4], and susceptibility to motion sickness [5] have all been noted to be predictive of increased emesis with chemotherapy. Treatment-related factors include the intrinsic emetogenicity of the cytotoxic agent(s), the dose and schedule, treatment setting, as well as additive effects of combinations [6].

Abstract: Purpose To update the 1999 American Society of Clinical Oncology guideline for antiemetics in oncology.

Abstract: Purpose Chemotherapy-induced nausea and vomiting (CINV) are major adverse effects of cancer chemotherapy. We compared the impact of acute (during the first 24 hours postchemotherapy) and delayed (days 2 through 5 postchemotherapy) CINV on patients’ quality of life (QoL) after highly or moderately emetogenic chemotherapy (HEC and MEC, respectively). Patients and Methods This prospective, multicenter, multinational study was conducted in 14 medical practices on cancer patients undergoing either HEC or MEC treatment. Patients recorded episodes of nausea and vomiting in a diary. Patients completed the Functional Living Index-Emesis (FLIE) questionnaire at baseline and on day 6. Results A total of 298 patients were assessable (67 HEC patients, 231 MEC patients). Emesis was reported by 36.4% of patients (13.2% acute, 32.5% delayed) and nausea by 59.7% (36.2% acute, 54.3% delayed). HEC patients reported significantly lower mean FLIE total score than MEC patients (95.5 v 107.8 respectively; P .0049). Among all patients, the nausea score was significantly lower than the vomiting score (50.0 and 55.3, respectively; P .0097). Of the 173 patients who experienced neither vomiting nor nausea during the first 24 hours postchemotherapy, 22.9% reported an impact of CINV on daily life caused by delayed CINV. Conclusion CINV continues to adversely affect patients’ QoL despite antiemetic therapy even after treatment with only moderately emetogenic chemotherapy regimens, and even in the subgroup of patients who do not experience nausea and vomiting during the first 24 hours. On the basis of the FLIE results in this study, nausea had a stronger negative impact on patients’ daily lives than vomiting.