Let me introduce you to Christine.
Christine is a 42-year-old African American female with stage IV colon cancer. She is currently on therapy with FOLFIRI (fluoruracil, leucovorin, irinotican) plus cetuximab every 21 days. She may win the unwanted prize for having the most struggles with chemotherapy-induced nausea and vomiting (CINV).
We have tried all combinations of things to help her, most recently giving not only intravenous (IV) aprepitant, dexamethason, and palonosetron on the day of treatment, but also applying a granisetron patch for a week beginning on day 3, taking prochlorperazine as needed, and taking lorazepam prior to arriving.
Christine normally weighs around 270 pounds, but will literally have a fluctuation of around 20 pounds in the 3 weeks between her treatments. A majority of her nausea and vomiting issues have been in those initial 2 weeks and we have struggled to manage this well. It is difficult when the chemotherapy we are giving is controlling her incurable disease, but the side effects of therapy are wreaking havoc.
When our oncology practice was introduced to rolapitant (Varubi), a light bulb went off. This just might be the drug to finally help Christine. Rolapitant is the latest breakthrough in treatment for CINV. It is an NK-1 antagonist, given as an oral dose (two 90 mg tablets) taken 1–2 hours before chemotherapy administration. This would replace IV aprepitant in her care plan, at least for the initial trial. Rolapitant has a half-life of 7 days, potentially giving her 10-14 days of nausea coverage.
Two weeks ago I gave Christine rolapitant 180 mg just as described. I then called her 1 week later and amazingly, unlike so many treatments before, she wasn’t vomiting, she was eating well, and her weight was stable. She was thrilled. I was thrilled. It is always a bit scary when you try something new on a patient. You pray that it works!
Perhaps even more exciting is that the drug manufacturer is investigating an IV form of rolapitant, determining if a single IV dose would be equal to the oral form. It’s possible we could see approval for this in the very near future. This would help to provide even more options for patients suffering with severe CINV.
Do you have patients who are currently struggling with CINV despite all the treatment options available? Perhaps rolapitant is their answer, too.