Abdel-Rahman, O., & Fouad, M. (2016). Rolapitant: A pooled analysis of its efficacy and safety in the prophylaxis of chemotherapy-induced nausea and vomiting. Future Oncology, 12, 871–879. 

DOI Link

Purpose

STUDY PURPOSE: To provide a detailed assessment of the efficacy and toxicity of regimens based on rolapitant in the prophylaxis of chemotherapy-induced nausea and vomiting (CINV)

TYPE OF STUDY: Meta-analysis and systematic review

Search Strategy

DATABASES USED: MEDLINE, Cochrane library, Google Scholar, meeting abstracts from ASCO and ESMO
 
INCLUSION CRITERIA: Randomized controlled trials that evaluated rolapitant-based antiemetic regimens in the prophylaxis of CINV with efficacy and/or toxicity measures reported
 
EXCLUSION CRITERIA: Non-English language records were excluded.

Literature Evaluated

TOTAL REFERENCES RETRIEVED: 140
 
EVALUATION METHOD AND COMMENTS ON LITERATURE USED: One hundred thirty-two did not meet eligibility criteria and were excluded. The full text search resulted in the removal of four studies of the eight final studies. No further specifics were provided on the process.

Sample Characteristics

  • FINAL NUMBER STUDIES INCLUDED = 4 
  • TOTAL PATIENTS INCLUDED IN REVIEW = 2,856
  • SAMPLE RANGE ACROSS STUDIES: 454–1,332 patients
  • KEY SAMPLE CHARACTERISTICS: Three studies included patients taking highly emetogenic chemotherapy, one study included patients administered moderately emetogenic chemotherapy. Patients ethnicities are unknown.

Phase of Care and Clinical Applications

PHASE OF CARE: Active antitumor treatment

Results

The pooled RR for the complete response (CR) was 1.23 (95% CI [1.18, 1.33], p < 0.00001) in the overall phase, 1.12 (95% CI [1.02, 1.24], p = 0.02) in the acute phase, and 1.19 (95% CI [1.13, 1.26], p < 0.00001) in the delayed phase. The pooled RR for no significant nausea in the overall phase was 1.17 (95% CI [1.04, 1.32], p = 0.008), and the pooled RR for no emesis in the overall phase was 1.24 (95% CI [1.18, 1.31], p < 0.00001). The efficacy analyses demonstated that rolapitant-based regimens are associated with higher rates of CR (both in overall, acute, and delayed phases). No significant nausea was present and no emesis was present compared with control regimens in highly and moderately emetogenic chemotherapy. The pooled RR of all grade constipation was 1 (95% CI [0.55, 1.82], p = 0.61), and the pooled RR of all grade headache was 1.05 (95% CI [0.57, 1.96], p = 0.87). Therefore, rolapitant-based regimens are not associated with an increased RR for constipation or headache compared with antiemetic control regimens.

Conclusions

This analysis demonstrated that rolapitant-based regimens are associated with higher rates of CR, no significant nausea, and no emesis compared with control regimens in highly and moderately emetogenic chemotherapy. In addition, no increased risk of toxicity with constipation or headache exists when compared with standard antiemetic control regimens. The authors concluded that rolapitant is a valid addition to other available standard antiemetic regimens for highly and moderately antiemetic chemotherapy.

Limitations

  • Limited number of studies included
  • Low sample sizes
  • Limited information on patient age, sex, diagnosis, and treatment regimens

Nursing Implications

Rolapitant is associated with higher CR rates, no significant nausea, and no emesis compared to other control regimens in highly and moderately emetogenic chemotherapy without increased toxicity. Rolapitant should be a recommended addition to control regimens that do not include a neurokinin inhibitor.

Legacy ID

6015