Chemotherapy-induced Nausea and Vomiting
Conditions
Keywords
Rolapitant, Nausea, Vomiting, CINV, Chemotherapy
Brief summary
This is a Phase 3, multicenter, randomized, parallel-group, double-blind, active-controlled study of rolapitant in subjects receiving HEC. Rolapitant or placebo will be administered prior to initiation of chemotherapy on Day 1 with granisetron and dexamethasone. Subjects will record all events of emesis and use of rescue medication for established nausea and/or vomiting, and will indicate the severity of nausea they experienced in each of the previous 24 hours in the Nausea and Vomiting (NV) Subject Diary prior to HEC administration through Day 6 of Cycle 1. Health-related quality of life will be measured by the FLIE Questionnaire on Day 6 of Cycle 1. Safety and tolerability will be assessed by clinical review of adverse events (AEs), physical examinations, electrocardiograms (ECGs), and safety laboratory values. All subjects are expected to complete Cycle 1 and will have the option of participating in up to five additional cycles.
Detailed description
This is a Phase 3, multicenter, randomized, parallel-group, double-blind, active-controlled study of rolapitant in subjects receiving HEC (≥60 mg/m2 of cisplatin-based chemotherapy). Study drug will be administered 1 - 2 hours prior to initiation of chemotherapy on Day 1. Granisetron and dexamethasone will be administered approximately 30 minutes before initiation of chemotherapy on Day 1,except in patients receiving taxanes as part of cisplatin-based chemotherapy. Subjects will record all events of emesis and use of rescue medication for established nausea and/or vomiting and will indicate the severity of nausea they experienced in each of the previous 24 hours in the NV Subject Diary prior to HEC administration through Day 6 in Cycle 1. Dexamethasone 8 mg twice daily (part of study regimen) on Days 2 through 4 is NOT considered rescue therapy. Health-related quality of life will be measured by the FLIE Questionnaire on Day 6 of Cycle 1. Safety and tolerability will be assessed by clinical review of AEs, physical examinations including complete neurological assessment, vital signs,electrocardiograms (ECGs), and safety laboratory values including BUN andcreatinine. All subjects are expected to complete Cycle 1 and will have the option of participating in up to five additional cycles. The study will investigate the efficacy of rolapitant for the treatment of CINV during an initial chemotherapy cycle (Cycle 1). Safety analyses will include data from Cycle 1 and from subsequent cycles. At the Screening Visit, blood samples may be collected and stored in this study and maybe analyzed for future biomarker research related to safety and efficacy. Analysis of these samples may include DNA, RNA, or protein markers. The biomarker blood samples will be stored for up to 2 years post study completion. In addition, PK samples will be collected from subjects enrolled in selected sites.
Interventions
(4 X 50 mg capsules) 200 mg PO
10 mcg/kg IV
20 mg PO and 8 mg PO
(4 X 0 mg capsules) 0 mg PO
Sponsors
Study design
Eligibility
Inclusion criteria
* 18 years of age or older, of either gender, and of any race * has never been treated with cisplatin and is to receive the first course of cisplatin-based chemotherapy (≥60 mg/m2) * Karnofsky performance score of ≥60 * Predicted life expectancy of ≥4 months * Adequate bone marrow, kidney, and liver function
Exclusion criteria
* Contraindication to cisplatin, granisetron, or dexamethasone * Is pregnant or breast feeding * Has previously received cisplatin or subject is planning to receive multiple days of cisplatin in a single cycle * Has taken the following agents within the last 48 hours 5-HT3 antagonists,Phenothiazines,Benzamides,Domperidone,Cannabinoids,NK1 antagonist, Benzodiazepines * Scheduled to receive any other chemotherapeutic agent with an emetogenicity level of 4 or above (Hesketh Scale) from Day 2 through Day 6, except on Day 1. * Scheduled to receive any radiation therapy to the abdomen or pelvis from Day -5 through Day 6 * Has received systemic corticosteroids or sedative antihistamines within 72 hours of Day 1 of the study except as premedication for chemotherapy (e.g., taxanes, pemetrexed) * symptomatic primary or metastatic CNS disease. * Has ongoing vomiting, retching, clinically significant nausea caused by any etiology, or has a history of anticipatory nausea and vomiting. * Has vomited and/or has had dry heaves/retching within 24 hours prior to the start of cisplatin-based chemotherapy on Day 1 in Cycle 1.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| No Emetic Episodes and No Rescue Medication | >24 to 120 hours post chemotherapy | The primary objective of this study is to determine whether administration of rolapitant with granisetron and dexamethasone improves CINV in the delayed phase (\>24 to 120 hours) of CINV compared with administration of placebo with granisetron and dexamethasone in subjects receiving HEC. The primary outcome will be based on complete response (defined as no emetic episodes and no rescue medication) in the delayed phase (\>24 to 120 hours). |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Acute Phase Response | 0 to 24 hours | To determine the effect of rolapitant on complete response rates in the acute (0 to 24 hours)phase of CINV |
| Overall Response Rate | 0 to 120 hours | To determine the effect of rolapitant on complete response rates in the overall (0 to 120 hours) phase of CINV. |
Countries
United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Rolapitant + Granisetron + Dexamethasone * Oral dose of rolapitant 180 mg (equivalent to 200 mg rolapitant hydrochloride monohydrate) 1-2 h before administration of chemotherapy
* Granisetron (10 μg/kg intravenously) about 30 min before chemotherapy
* Dexamethasone (20 mg orally) about 30 min before chemotherapy, and dexamethasone 8 mg orally twice daily on days 2-4 | 264 |
| Placebo + Granisetron + Dexamethasone * Matching placebo 1-2 h before administration of chemotherapy
* Granisetron (10 μg/kg intravenously) about 30 min before chemotherapy
* Dexamethasone (20 mg orally) about 30 min before chemotherapy, and dexamethasone 8 mg orally twice daily on days 2-4 | 262 |
| Total | 526 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | Adverse Event | 28 | 32 |
| Overall Study | Chemo completed or Change in Therapy | 70 | 67 |
| Overall Study | Death | 5 | 7 |
| Overall Study | Disease Progression | 11 | 10 |
| Overall Study | Lack of Efficacy | 3 | 4 |
| Overall Study | Lost to Follow-up | 6 | 3 |
| Overall Study | Other Reasons | 27 | 30 |
| Overall Study | Physician Decision | 20 | 19 |
| Overall Study | Protocol Violation | 11 | 11 |
| Overall Study | Withdrawal by Subject | 43 | 43 |
Baseline characteristics
| Characteristic | Placebo + Granisetron + Dexamethasone | Total | Rolapitant + Granisetron + Dexamethasone |
|---|---|---|---|
| Age, Continuous | 57.7 years STANDARD_DEVIATION 11.15 | 57.3 years STANDARD_DEVIATION 10.62 | 57.0 years STANDARD_DEVIATION 10.08 |
| Ethnicity (NIH/OMB) Hispanic or Latino | 34 Participants | 67 Participants | 33 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 228 Participants | 459 Participants | 231 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) American Indian or Alaska Native | 0 Participants | 2 Participants | 2 Participants |
| Race (NIH/OMB) Asian | 56 Participants | 117 Participants | 61 Participants |
| Race (NIH/OMB) Black or African American | 3 Participants | 5 Participants | 2 Participants |
| Race (NIH/OMB) More than one race | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 24 Participants | 45 Participants | 21 Participants |
| Race (NIH/OMB) White | 179 Participants | 357 Participants | 178 Participants |
| Sex: Female, Male Female | 112 Participants | 222 Participants | 110 Participants |
| Sex: Female, Male Male | 150 Participants | 304 Participants | 154 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — |
| other Total, other adverse events | 187 / 263 | 198 / 263 |
| serious Total, serious adverse events | 37 / 263 | 54 / 263 |
Outcome results
No Emetic Episodes and No Rescue Medication
The primary objective of this study is to determine whether administration of rolapitant with granisetron and dexamethasone improves CINV in the delayed phase (\>24 to 120 hours) of CINV compared with administration of placebo with granisetron and dexamethasone in subjects receiving HEC. The primary outcome will be based on complete response (defined as no emetic episodes and no rescue medication) in the delayed phase (\>24 to 120 hours).
Time frame: >24 to 120 hours post chemotherapy
Population: MITT
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Rolapitant + Granisetron + Dexamethasone | No Emetic Episodes and No Rescue Medication | 72.7 percentage of participants |
| Placebo + Granisetron + Dexamethasone | No Emetic Episodes and No Rescue Medication | 58.4 percentage of participants |
Acute Phase Response
To determine the effect of rolapitant on complete response rates in the acute (0 to 24 hours)phase of CINV
Time frame: 0 to 24 hours
Population: MITT
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Rolapitant + Granisetron + Dexamethasone | Acute Phase Response | 83.7 percentage of participants |
| Placebo + Granisetron + Dexamethasone | Acute Phase Response | 73.7 percentage of participants |
Overall Response Rate
To determine the effect of rolapitant on complete response rates in the overall (0 to 120 hours) phase of CINV.
Time frame: 0 to 120 hours
Population: MITT
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Rolapitant + Granisetron + Dexamethasone | Overall Response Rate | 70.1 percentage of participants |
| Placebo + Granisetron + Dexamethasone | Overall Response Rate | 56.5 percentage of participants |