Is Rolapitant Effective in Reducing the Incidence of Chemotherapy-Induced Nausea and Vomiting (CINV) in Patients Receiving Emetogenic Chemotherapy?

Objective: The objective of this selective EBM review is to determine whether or not rolapitant is safe and effective in reducing the incidence of chemotherapy induced nausea and vomiting (CINV) in patients receiving emetogenic chemotherapy. Study Design: This review is based on three randomized controlled trials (RCTs) all published in 2015. The studies compared the safety and efficacy of rolapitant in decreasing the incidence of CINV. Data Sources: All articles used were published in English, in peer-reviewed journals, and found using PubMed and the Cochrane Review database. Outcomes Measured: All included studies measured the safety and efficacy of rolapitant on CINV. Specifically, studies evaluated incidence of emesis, use of rescue medications, and clinically significant nausea based on patient reporting in a study diary and answers to a studyspecific questionnaire. Results: Rapoport et al.1 found statistical significance (p = 0.032) in the effectiveness of rolapitant in reducing CINV in the overall phase. Rapoport et al.2 also found statistical significance of this (p = 0.0013) as well as Schwartzberg et al.3 (p = 0.0012). In the two studies conducted by Rapoport et al. it was found that rolapitant achieved statistical significance in achieving a CR in the acute, delayed, and overall phases. In Schwartzberg et al.3 rolapitant did not achieve a significant response in the acute phase but it did in the delayed phase. Overall rolapitant was well tolerated and any mild side effects were presumed to be a result of the underlying malignancy or the chemotherapy. Conclusions: Results of all 3 studies included indicate that prophylactic 180mg rolapitant is effective in reducing the incidence of CINV in patients receiving either moderately or highly emetogenic chemotherapy. Since all three studies used concomitant 5-HT3 receptor antagonists, further studies are warranted to prove the benefit of rolapitant as monotherapy. The question of the effectiveness of rolapitant as compared to others in its same class (NK-1 receptor antagonists) remains as well