Introduction

Rolapitant (trade name EU: Varuby, U.S.: Varubi) has been approved in Germany since April 2017 in combination with other drugs for use in adults who are receiving chemotherapy for the treatment of cancer. The drug is meant to prevent nausea and vomiting and is an option for the following people:

  • People who are having chemotherapy that often (in 30 to 90 out of 100 people) causes nausea and vomiting.
  • People who are having chemotherapy that almost always (in more than 90 out of 100 people) causes nausea and vomiting.

Chemotherapy is a common treatment for cancer, alongside surgery and radiation. It aims to stop the growth of cancer cells, but the drugs that are used also damage healthy cells. This can cause side effects such as hair loss, anemia, nausea, vomiting and diarrhea.

If chemotherapy affects the part of the brain that controls nausea and vomiting, it is called emetogenic chemotherapy. Nausea and vomiting may arise soon, within 24 hours of chemotherapy, or it may be delayed and only start 24 hours after starting the treatment.

Rolapitant, a neurokinin-1 receptor antagonist, affects the nervous system. It inhibits the effect of chemical messengers on the "vomiting center" in the brain. It is combined with a serotonin receptor antagonist and the drug dexamethasone.

Application

Rolapitant is taken in the form of tablets (90mg) two hours before the start of each course of chemotherapy at a dosage of 180 mg. At least two weeks have to pass until rolapitant can be taken again.

Other treatments

Various standard treatments for preventing nausea and vomiting are available for patients who are having chemotherapy. The options depend on what type of chemotherapy is used:

  • Patients receiving chemotherapy that often causes nausea can combine a serotonin receptor antagonist and dexamethasone. In chemotherapy with carboplatin, a neurokinin-1 receptor antagonist is also used.
  • Patients receiving chemotherapy that almost always causes nausea can have triple therapy with a serotonin receptor antagonist, a neurokinin-1 receptor antagonist and dexamethasone.

Assessment

In 2017, the Institute for Quality and Efficiency in Health Care (IQWiG, Germany) wanted to look into the advantages and disadvantages of rolapitant compared with the standard treatments for nausea and vomiting caused by chemotherapy.

But the manufacturer didn't provide any suitable data with which to do the assessment.

More information

This information summarizes the main results of a review produced by the Institute for Quality and Efficiency in Health Care (IQWiG, Germany). The review was commissioned by the German Federal Joint Committee (G-BA) as part of the “early benefit assessment of medications.” On the basis of the review and the hearings received, the G-BA passed a resolution on the added benefit of rolapitant (EU: Varuby; U.S.: Varubi).