Emend – pro

Fosaprepitant (INN; trade names Emend for Injection, Ivemend) is an anti-emetic drug, administered intravenously. It is a prodrug of aprepitant.

In early 2006, the American Society of Clinical Oncology (ASCO) set out to update their 1999 treatment guidelines regarding antiemetics in oncology.
The committee also reviewed the treatment guidelines discussed at the Antiemetic Consensus Conference, hosted by the Multinational Association of Supportive Care in Cancer (MASCC) in 2004. This international conference facilitated consensus statements and recommendations by representatives from nine oncology organizations, which would be published in whole or in part with their individual organization’s antiemetic guidelines. The ASCO Update Committee used the findings from this meeting to expand on their own recommendations and to aid in preparing their update document. These guidelines served as the basis for NCCN and other recent guidelines.

In terms of treating nausea and vomiting in patients who experience symptoms due to chemotherapy of high emetic risk (cisplatin and noncisplatin groups) within 24 hours after treatment, three agents are included in the 2006 guidelines. 5-HT 3 serotonin receptor antagonists, corticosteroids (dexamethasone), and aprepitant are all effective in the acute treatment of emetic symptoms related to chemotherapy. The addition of aprepitant to ASCO’s updated guidelines is the one major difference from their previous recommendations. The Update Committee, after analyzing numerous studies involving these three agents and cisplatin, states that all three agents improve the symptoms of cisplatin-induced emesis. The committee is able to generalize this claim to include other agents in the high-risk emesis category due to the universal incidence of emesis with cisplatin (>99%). The incidence is so great that if an antiemetic agent is effective against cisplatin, efficacy against other chemotherapy agents in this high-risk category is assumed.

EMEND, in combination with other antiemetic agents, is indicated for prevention of:
Acute and delayed nausea and vomiting associated with initial and repeat courses of highly emetogenic cancer chemotherapy, including high-dose cisplatin.
Nausea and vomiting associated with initial and repeat courses of moderately emetogenic cancer chemotherapy.

It should be noted that NCCN  2012 on p. AE-1 and 2 does not require that there actually be nauseas with initial and repeat courses of highly emetogenic cancer chemotherapy.

Kris MG, Hesketh PJ, et al. American Society of Clinical Oncology guideline for antiemetics in oncology: update 2006. J Clin Oncol. 2006;24:2932-2947.

Roila F. Prevention of cisplatin-induced delayed emesis: still unsatisfactory. Support Care Cancer. 2000;8:229-232.

NCCN.ORG, Anti-emesis 2017cs

Armbruster, Wen-Jan Candy, Bayait, Frank, Papish, Steven Antiemetic guidelines for low and moderately low emetogenic potential chemotherapy Journal of Oncology Pharmacy Practice 1998 4: 212-213

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