Cancer Treatment Today

This drug is used mainly for Delayed Emesis (24 hours after chemotherapy): Recommendations for the prevention of delayed emesis in oncology patients receiving cisplatin and other agents of high emetic risk include the use of dexa­ methasone and aprepitant, – for the prevention of cisplatin and non-cisplatin delayed emesis. Aprepitant (oral) and fosaprepitant (intravenous prodrug) are indicated for the prevention of nausea and vomiting. Initially, the development of aprepitant was for the prevention of chemotherapy-induced nausea and vomiting, but its use and indications have since expanded to include post-operative nausea and vomiting. Aprepitant now has FDA approval for both indications.
The Multinational Association of Supportive Care in Cancer/European Society for Medical Oncology (MASCC/ESMO), the American Society of Clinical Oncology (ASCO), and the National Comprehensive Cancer Network (NCCN) make antiemetic therapy based guidelines based on the risk of emesis. An (NK-1) receptor antagonist is recommended in combination with a 5-HT3 receptor antagonist (e.g., ondansetron) and a glucocorticoid (often dexamethasone) for highly emetogenic chemotherapy (HECT) and moderately emetogenic chemotherapy (MECT)
Folfiri is moderately emetogenic chemotherapy and the use aprepitant is, therefore, medically appropriate.
A recent study by Hanaka et al concluded that aprepitant can be used as a safe antiemetic supportive therapy in elderly advanced colorectal cancer patients undergoing FOLFOX and FOLFIRI, as well as granisetron and dexamethasone.

NCCN.ORG, Supportive care 2021

Hanaka J, Takahashi M, Nakayama H, Terashima T. [Study of the Efficacy of Aprepitant in FOLFOX/FOLFIRI for Elderly Patients with Advanced Colorectal Cancer]. Gan To Kagaku Ryoho. 2016 May;43(5):583-6. Japanese. PMID: 27210087.

Aapro M, Carides A, Rapoport BL, Schmoll HJ, Zhang L, Warr D. Aprepitant and fosaprepitant: a 10-year review of efficacy and safety. Oncologist. 2015 Apr;20(4):450-8.