Several national and international guideline groups include EMEND as part of a standard antiemetic regimen for select patients.
The 2008 NCCN and MASCC antiemetic guidelines include fosaprepitant for Day 1 protection.
ASCO=American Society of Clinical Oncology; NCCN=National Comprehensive Cancer Network; ONS=Oncology Nursing Society;
MASCC=Multinational Association of Supportive Care in Cancer; AC=anthracycline+cyclophosphamide.
a
NCCN considers AC-based chemotherapy to be highly emetogenic.
b
NCCN also suggests that aprepitant should be given to select patients receiving other chemotherapies of moderate emetic risk
(eg. carboplatin, cisplatin, doxorubicin, epirubicin, ifosfamide, irinotecan, or methotrexate).
(eg. carboplatin, cisplatin, doxorubicin, epirubicin, ifosfamide, irinotecan, or methotrexate).
- References:1.Kris MG, Hesketh PJ, Somerfield MR, et al. American Society of Clinical Oncology guideline for antiemetics in oncology: update 2006. J Clin Oncol. 2006;24(18):2932–2947.
- 2.National Comprehensive Cancer Network. Clinical practice guidelines in oncology—v.3.2008: antiemesis. http://www.nccn.org/professionals/physician_gls/pdf/antiemesis.pdf. Published February 5, 2008. Accessed
July 16, 2008. - 3.Oncology Nursing Society. Putting Evidence Into Practice (PEP) Card. What interventions are effective in preventing and treating chemotherapy-induced nausea and vomiting (CINV)? ons.org/outcomes/pepcard/pdf/nausea-pepcard4-06.pdf. Accessed July 16, 2008.
- 4.Gralla RJ, Roila F, Tonato M. for Multinational Association of Supportive Care in Cancer. Perugia International Cancer Conference VII. Based on: the Consensus Conference on Antiemetic Therapy. mascc.org/media/Resource_centers/MASCC_Guidelines_Update.pdf. Updated March 2008. Accessed July 16, 2008.
Selected Important Risk Information
EMEND, when administered orally, is a moderate cytochrome P450 isoenzyme 3A4 (CYP3A4) inhibitor. Because fosaprepitant is rapidly converted to aprepitant, neither drug should be used concurrently with pimozide, terfenadine, astemizole, or cisapride. Inhibition of CYP3A4 by aprepitant could result in elevated plasma concentrations of these drugs, potentially causing serious or life-threatening reactions.
EMEND should be used with caution in patients receiving concomitant medications that are primarily metabolized through CYP3A4. Inhibition of CYP3A4 by EMEND could result in elevated plasma concentrations of these concomitant medications. Conversely, when EMEND is used concomitantly with another CYP3A4 inhibitor, aprepitant plasma concentrations could be elevated.
Because a small number of patients in clinical studies received the CYP3A4 substrates vinblastine, vincristine, or ifosfamide, particular caution and careful monitoring are advised in patients receiving these agents or other chemotherapy agents metabolized primarily by CYP3A4 that were not studied.
The efficacy of hormonal contraceptives may be reduced during coadministration with EMEND and for 28 days after the last dose of EMEND. Alternative or backup methods of contraception should be used during treatment with EMEND and for 1 month after the last dose of EMEND.
Coadministration of EMEND with warfarin may result in a clinically significant decrease in international normalized ratio (INR) of prothrombin time. In patients on chronic warfarin therapy, the INR should be closely monitored in the 2-week period, particularly at 7 to 10 days, following initiation of the 3-day regimen of EMEND with each chemotherapy cycle.
Before prescribing EMEND or EMEND for Injection, please read the Prescribing Information. The Patient Information also is available.
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